[Clinical evaluation of cefsulodin in Pseudomonas infections in children]

Cefsulodin (CFS) was evaluated for its safety and efficacy in 14 children with Pseudomonas aeruginosa infections. The diagnoses included pneumonia (4), sepsis (1), presumed sepsis (4), acute postoperative ascending cholangitis (1), acute postoperative peritonitis with wandering pneumonia (1), acute enterocolitis with acute UTI (1), recurrent UTI (1), and acute cystitis (1). CFS was administered intravenously with a daily dose of 93 to 299 mg/kg in the cases with normal renal functions. CFS was effective in all but one case both clinically and bacteriologically. A case of pneumonia whose isolate was resistant to CFS responded poorly. Mild transient eosinophilia was observed in 3 cases, but no severe adverse reactions were encountered. Peak MIC values of 18 clinical isolates of P. aeruginosa were 1.56 mcg/ml, 0.39 to 0.78 mcg/ml and 12.5 mcg/ml for CFS, gentamicin, and sulbenicillin, respectively. A half life of the serum CFS levels was 1.09 hours after intravenous bolus injection of 20 to 25 mg/kg of CFS (n = 2). A cerebrospinal-fluid level and biliary levels measured in cases with inflamed meninges or with cholangitis were well above the MIC value. From the present study, CFS appeared to be a safe and effective antibiotic when used in children with susceptible Pseudomonas infections. Combined use of another antibiotic should be considered in the case with polymicrobial infections because of the CFS's very narrow spectrum.

Absorption, excretion, and clinical efficacy of moxalactam in pediatric patients

Absorption and excretion of moxalactam were studied in 58 children between two and 14 years of age. Mean serum levels reached peaks of 96.6 and 76.0 micrograms/ml 15 min after intravenous injection of 20 and 10 mg of moxalactam/kg, respectively. The respective serum half lives were 103 and 83 min. Mean serum levels after intravenous drip infusion over a 1-hr interval reached peaks of 71.4 and 39.8 micrograms/ml at the end of the infusion of 20 and 10 mg/kg, respectively. The respective serum half lives were 103 and 94 min. Mean cumulative urinary recovery of the administered dose for the 6-hr interval after intravenous injection or drip infusion was approximately 73%. Among the patients from whom pathogens were isolated, satisfactory clinical response was obtained in 11 (92%) of 12 patients with meningitis, 4 (80%) of 5 patients with septicemia, all 9 patients with bronchitis, 32 (91.4%) of 35 patients with pneumonia, 33 (91.6%) of 36 patients with urinary tract infections, and all 8 patients with lymphadenitis or skin and soft-tissue infections. In all of the nine patients with meningitis for whom levels of the drug in cerebrospinal fluid were determined, levels of moxalactam were much higher than the minimal inhibitory concentrations for the pathogens, and these levels were associated with prompt clinical and bacteriologic responses. Adverse reactions were noted in only four of 279 treated patients.

[Clinical evaluation of cefmenoxime in the pediatric infections]

Cefmenoxime (CMX) was evaluated in 25 children with a suspicion of bacterial infection. Of the 20 confirmed bacterial infections, 19 were cured by CMX therapy (effective rate, 95%). The diagnoses included acute pharyngotonsillitis (4), acute bronchitis (1), pneumonia (7), streptococcal dacryocystitis (1), infections accompanied with acute leukemia (4), and acute urinary tract infections (3). The etiologic pathogens were beta-hemolytic Streptococcus group A (1), and F (1), Staphylococcus aureus (4), Haemophilus influenzae (4), Escherichia coli (4), Klebsiella pneumoniae (2), etc. CMX was very effective for 2 children with respiratory infections due to ampicillin resistant H. influenzae type b. The half life of serum concentration of CMX was 0.76 +/- 0.17 hour after an intravenous bolus injection. A cerebrospinal fluid level of CMX was 5.2 mcg/ml 1 hour after intravenous injection of 1 g (23.8 mg/kg) in a child with inflamed meninges. However this level was not as high as those of cefotaxime, latamoxef, or ceftizoxime measured in the same case. No severe adverse reaction was encountered with CMX therapy. The data suggest that CMX is a safe and effective parenteral antibiotic when used in children with susceptible bacterial infections.

[Cyclocytidine therapy for the herpes-group virus infection in children. A preliminary study]

Cyclocytidine (Cyclo-C) was evaluated as an antiviral chemotherapeutic agent in 10 children with herpes-group virus infections. The diagnoses of the patients were severe cytomegalovirus (CMV) syndrome with pneumonitis in acute leukemia (2), congenital or infantile CMV infections (3), herpes zoster encephalitis in acute leukemia (1), severe nosocomial varicella in compromised patients (2), varicella pneumonia (1) and acute encephalitis due to herpes simplex type-1 (1). Cyclo-C was effective in all the cases with acute infections, although it had no benefit on the course of chronic CMV infection with irreversible damages. However, complete or transient ceasing of viral shedding was obtained in all the 5 cases with CMV infections. From the present small open study, further evaluation of Cyclo-C as an antiviral agent especially in acute CMV infections is warranted.

[Fundamental and clinical investigations of cefotaxime in neonates]

Fundamental and clinical investigations of cefotaxime were carried out in neonates. The following results were obtained. 1. Seven neonates with serious infections caused by identifiable pathogens, including Group B streptococcal meningitis and Group A streptococcal sepsis, were treated by intravenous bolus injection of 20-200 mg/kg of cefotaxime 2 or 3 times daily (60-400 mg/kg/day). The clinical efficacy of cefotaxime was assessed to be good in 6 patients and fair in 1 patient. Bacteriological efficacy was evaluable in 4 patients, all of whom displayed complete eradication of pathogens. 2. Among 22 neonates administered cefotaxime, adverse reactions appeared in 3 patients. Adverse reactions consisted of a transient skin rash in 1 patient and elevation of GOT in 2 patients. 3. Serum concentrations of cefotaxime and desacetyl cefotaxime were investigated in 8 mature infants and 5 immature infants on days 0-7 postpartum. A single intravenous injection of 20 mg/kg produced peak serum concentrations of 31.8-49.7 mcg/ml, associated with a half-life of 1.38-4.47 hours, in mature infants and peak serum concentrations of 35.5-55.0 mcg/ml, associated with a half-life of 3.22-6.43 hours, in immature infants. On days 0-2 postpartum the half-life was longer than on subsequent days. This tendency was particularly remarkable in immature infants. Serum concentrations of desacetyl cefotaxime displayed high individual variations; no consistent trends were noted. 4. Cefotaxime and desacetyl cefotaxime serum concentrations were studied in 3 neonates undergoing exchanged transfusion (exchanged volume 177-180 ml/kg) on 1-4 days postpartum. Serum concentrations of cefotaxime after exchanged transfusion were equivalent to 32.6-63.9% of the pretransfusion level, while those of desacetyl cefotaxime were 75.2-106% of the pretransfusion level. 5. Minimal inhibitory concentration (MICs) and minimal bactericidal concentration (MBCs) of cefotaxime were determined against clinical isolates. MICs for inoculum sizes of 10(8)/ml and 10(6)/ml were respectively 3.13-25 mcg/ml and 3.13-25 mcg/ml against S. aureus, 0.024 mcg/ml and 0.012 mcg/ml against Group A Streptococcus, 0.05 mcg/ml and 0.05 mcg/ml against Group B Streptococcus and 0.39 mcg/ml and 0.1 mcg/ml against E. coli. MBCs for an inoculum size of 10(6)/ml were 3.13-100 mcg/ml or over against S. aureus, 0.012 mcg/ml against Group A Streptococcus, 0.39 mcg/ml against Group B Streptococcus and 1.56 mcg/ml against E. coli.

Muscarinic cholinoceptors mediate neurally evoked pigment aggregation in glass catfish melanophores

Sympathetic innervation to the melanophores of a siluroid Parasilurus has been the sole instance of such innervation among lower vertebrates, in which the peripheral transmission to the effector cells is peculiarly cholinergic (Fujii and Miyashita, 1976). In an effort to find a similar case, we studied the nature of transmission of melanophores of a glass catfish Kryptopterus. Electrical nervous stimulation brought about melanosome aggregation in the melanophores. While catecholamines were found ineffective, acetylcholine and its analogues were potently active in aggregating pigment. Atropine or scopolamine interferred with the action of both nervous stimulation and acetylcholine. Physostigmine, on the other hand, augmented the cholinergic effects. The conclusion was that the transmission was cholinergic, being mediated by cholinoceptors of muscarinic type, as in the case of Parasilurus.

[Clinical results of 9,3"-diacetylmidecamycin in the field of pediatrics (author's transl)]

MOM was administered at a daily dose of 20 to 40 mg/kg q.i.d. orally to 65 pediatric patients. These consisted of 37 cases of acute feverish respiratory tract infection, 13 cases of Mycoplasma infection, 1 case of scarlet fever and 14 cases of whooping cough. Forty pathogenic bacteria were isolated from the 37 patients with acute feverish respiratory tract infection and 1 pathogenic bacteria was isolated from the patient with scarlet fever. Thirty-five of these clinical isolates disappeared as a result of MOM administration. For these 65 cases, the clinical efficacy was good in 51 cases (78.5%), fair in 5 cases (all whooping cough) and poor in 9 cases. Twelve strains of St. pyogenes were isolated from 12 cases and 3 of these isolates persisted (25%). Ten strains of S. aureus were isolated from 10 cases and 1 of these isolates persisted. Superinfection was observed in 3 cases, 2 of which were the same species. Although the clinical effect in the 40 mg/kg/day treatment group was superior to the effects in the 20 mg/kg/day and 30 mg/kg/day treatment groups, the difference was not statistically significant.

[Clinical evaluation of ceftizoxime in the pediatric infections (author's transl)]

Ceftizoxime (FK 749, CZX) was evaluated in 24 children with a suspicion of bacterial infection. Of the 17 confirmed bacterial infections, 16 were shown to be effective (effective rate, 94.1%). The diagnosis included acute pharyngitis (2), pneumonia (6), staphylococcal empyema (1), cervical purulent lymphadenitis (2), acute enterocolitis (2), acute pyelonephritis (1), SSSS (1) and suspected septicemia (2). The etiological pathogens recovered were Streptococcus anginosus (1), Streptococcus pneumoniae (1), Staphylococcus aureus (2), Haemophilus influenzae (3), enteropathogenic Escherichia coli (1) etc. A case of suspected Pseudomonas aeruginosa septicemia was not effectively treated with CZX. The serum half-life of CZX was 1.36 hours after intravenous bolus infection. A cerebrospinal fluid level of CZX was 6.2 mcg/ml 1 hour after intravenous bolus injection of 1 g (23.8 mg/kg) in a child with inflamed meninges. No severe adverse reaction was encountered with the CZX therapy. The data suggest that CZX is an excellent candidate for the first choice parenteral antibiotic in the pediatric infections.

Receptor mechanisms in fish chromatophores--V. MSH disperses melanosomes in both dermal and epidermal melanophores of a catfish (Parasilurus asotus)

1. Synthetic alpha-MSH was tested for its action on dermal and epidermal melanophores of the siluroid catfish. Parasilurus asotus. 2. MSH did not produce melanosome aggregation in these melanophores. 3. It was, however, very effective in bringing about pigment dispersion in dermal melanophores. 4. Epidermal melanophores were also responsive to MSH, although the rate and the degree of the response was smaller than those of the dermal melanophores. 5. A possible role of MSH in skin color changes in vivo is discussed.

[Clinical studies on cefroxadine in the field of pediatrics (author's transl)]

Cefroxadine dry syrup was administered to 57 children with acute febrile respiratory tract infections and 2 children with scarlet fever in the dose of 40 mg/kg/day q.i.d. for 2 approximately 7 days. 65 strains of organism were isolated as pathogen from the 59 patients, and 50 of the 65 strains (76.9%) showed bacteriologically good responses. Clinically, 55 children (93.2%) had good response. Out of 63 strains isolated from the 57 cases with respiratory infections, 48 strains (76.2%) showed good bacteriological response. As for the type of pathogen, all strains of Staphylococcus aureus, 86.4% of Streptococcus haemolyticus and 90.0% of Streptococcus pneumoniae had good response, but as for Haemophilus influenzae it was only 47.6%. In one child, Streptococcus pneumoniae appeared during cefroxadine treatment in addition to the preexisting Haemophilus influenza. From the 4 children having no response for their respiratory infections, H. influenzae were isolated in 3 cases and Streptococcus haemolyticus was isolated in 1 case, before starting the treatment. As for side effects, mild diarrhea developed in only 3 children.

Development of antibodies to OEP, exotoxin A and exoenzymes of Pseudomonas aeruginosa in man

Antibody titers to OEP, exotoxin A and exoenzymes (protease and elastase) in normal sera of 256 specimens of cord blood, children and adults were measured by passive hemagglutination test. Serum antibody to exotoxin A was detected in cord blood samples. The level of mean antibody titers dropped during the first year of age, then rose and reached a plateau at the age of 2 to 5 years and dropped thereafter. Mean antibody titers to OEP by age groups were similar to those of exotoxin A. Antibodies to exoenzymes were not detectable initially, but the level rose during the second year of age and reached a plateau during childhood. Positive antibody titers (1:20) to exotoxin A and OEP were found in all sera belonging to some age groups between 11 to 30 years. The rate of acquisition of antibodies to exoenzymes was low. As for the antibodies to exotoxin A, the disappearance of detectable antibody by treatment with 2-mercaptoethanol was observed during the age of 1 to 4 years. Initial pseudomonas colonization may be common and asymptomatic in infants and young children.

[Laboratory and clinical evaluation of cefmetazole in the newborn infants (author's transl)]

1. Medium to large amount of CMZ (100-270 mg/kg/day) was administered to 4 cases of neonatal infants having severe infections due to pathogenic E. coli and sepsis due to E. coli CMZ was remarkably effective in all cases, and the causative bacteria disappeared in 100%. 2. Among 10 cases which administered CMZ, 5 cases showed side effect. Eruption, diarrhea and increase of GOT, GPT and LDH activities were observed but no case suggested interruption of administration. 3. Blood level of CMZ was determined in 4 cases of 0-1 day old, premature infants. The half life of CMZ was 8.55-15.3 hours, prolonged considerably, and 12 hours after one shot (20 mg/kg) of intravenous CMZ administration, 20.2 microgram/ml of blood level was maintained. 4. Intraspinal CMZ level was determined in aseptic meningitis. When one shot 50 mg/kg CMZ was given intravenously, intraspinal CMZ levels after 30 minutes and 1 hour were 20.3 microgram/ml and 34.5 microgram/ml, respectively, and distribution of CMZ in the cerebrospinal fluid was shown to be excellent. 5. Exchange blood infusion (amount of exchange, 170 ml/Kg) was performed in a small premature newborn baby, and blood transformation of CMZ was examined. It was found as the result that the blood level of CMZ was decreased to 53% of the pretreated level. 6. MIC of CMZ was examined in 3 strains of E. coli isolated from blood and cerebrospinal fluid. MICs were 0.39-0.78 microgram/ml when 10(6)/ml was inoculated and 0.78-1.56 when 10(8)/ml was inoculated.

[Clinical evaluation of cefotiam therapy in children (author's transl)]

Cefotiam (CTM) was evaluated for its safety and efficacy in children. Twenty-six patients were treated with 40 to 200 mg/kg per day of CTM by intravenous administrations. The diagnosis of the patients were acute pharyngitis (2), acute bronchitis (1), pneumonia (4), empyema (2), urinary tract infection (2), typhoid fever (1), acute enterocolitis (2), partially-treated purulent meningitis (1), and suspected septicemia in neuroblastoma (1); and the remaining ten patients were considered to have nonbacterial infections. The pathogens recovered were Streptococcus pyogenes (1), Streptococcus pneumoniae (1), Staphylococcus aureus (4), Haemophilus influenzae (4), Escherichia coli (1), enteropathogenic Escherichia coli (1), Salmonella typhi (1), and Campylobacter jejuni (1). All but two patients of bacterial infections were cured after the CTM therapy, and the rate of efficacy was 87.5%. Diarrhea (3), urticaria (1), transient elevation of GOT and GPT (1), and transient eosinophilia (3) were found to be associated with the CTM therapy. However, no severe adverse reactions were encountered. Half life of the serum CTM level was 0.93 +/- 0.13 hours, and excretion into the urine was rapid. CSF concentration obtained 1 hour after an intravenous injection of 21 mg/kg of CTM in a case with inflamed meninges was 1.5 mcg/ml, and the CSF/serum ratio was 9.0%. From these data, CTM appears to be a safe and effective antibiotic when used in children with susceptible bacterial infections.

[Clinical evaluation of 6059-S therapy in children (author's transl)]

A new semisynthetic 1-oxa-beta-lactam derivative, 6059-S, was evaluated for its safety and efficacy in children. Twenty-five patients were treated with 10 to 274 mg/kg per day of 6059-S by intravenous administrations. The diagnosis of the patients were acute pharyngitis (2), acute bronchitis (2), pneumonia (4), pertussis (4), acute enterocolitis (2), recurrent urinary tract infection (2), suspected septicemia (3), and acute purulent meningitis (1); and the remaining 5 patients were considered to have nonbacterial infections. The pathogens recovered were Streptococcus pneumoniae (1), Haemophilus influenzae (4), Haemophilus parainfluenzae (1), Enterobacter cloacae (1), Enterobacter aerogenes (1), Proteus morganii (1), Psuedomonas aeruginosa (2) and Salmonella typhimurium (1). All the patients of bacterial infections were cured after the 6059-S therapy. However, Pseudomonas aeruginosa and Salmonella typhimurium were not eradicated after the 6059-S therapy, and the rate of bacterial disappearance was 75%. Diarrhea (3), precordial pain (2, only in cases with high-dose therapy), transient elevation of GOT and GPT (2), and transient eosinophilia (2) were found to be associated with the 6059-S therapy. However, no severe adverse reactions were encountered. Half life of the serum 6059-S level was 1.34 +/- 0.16 hours. CSF concentrations in a case with Haemophilus influenzae meningitis ranged 4.0 to 9.7 mcg/ml after an intravenous injection of 34.3 to 75 mg/kg of 6059-S. From the present study, 6059-S appears to be a safe and effective antibiotic when used in children with susceptible bacterial infections. It remains to be further determined whether 6059-S is superior to ABPC in the treatment of Haemophilus influenzae meningitis.

[Clinical evaluation of cefoxitin in children (author's transl)]

Cefoxitin (CFX) was evaluated for its safety and efficacy in children. Fifteen patients were treated with 73-125 mg/kg per day of CFX by intravenous administrations. The diagnosis of the patients were acute pharyngitis (4), pneumonia (2), pertussis and pneumonia (1), urinary tract infection (3); and the remaining 5 patients were esteemed to have nonbacterial infections. All the 10 patients of bacterial infections were cured after the CFX therapy. The pathogens recovered were Streptococcus pyogenes (1), Streptococcus pneumoniae (3), Haemophilus influenzae (2), Escherichia coli (2), enteropathogenic Escherichia coli (1), and Klebsiella pneumoniae (1). All the strains isolated were susceptible to CFX, but the 2 isolates of Haemophilus influenzae had relatively high MIC values (12.5 mcg/ml). Diarrhea (3 cases) and transient neutropenia (1 case) were found to be associated with the CFX therapy. However, no severe adverse reactions were encountered. Half-life of the serum level was short (24.1 minutes) and excretion into the urine was rapid. CSF concentration obtained 30 minutes after an intravenous injection of 50 mg/kg of CFX in 1 case with inflamed meninges was considerably high (8.3 mcg/ml). CFX appears to be a safe and effective antibiotic when used in children with susceptible bacterial infections.

[Clinical results of cefadroxil in pediatric field (author's transl)]

Cefadroxil was administered at a daily dose of 50 mg/kg in 113 children including acute respiratory tract infections suspected to be a bacterial infection and other febrile diseases. Among 41 cases in which pharyngeal culture was made twice before and after administration or urine and feces cultures were made, 20 cases (48.8%) were good bacteriologically, 5 cases (12.2%) were poor, and 16 cases (39.0%) were unknown. Clinical efficacy was obtained in 105 cases (92.9%) out of 113 cases. Microbial substitution was noticed in 12 cases (29.3%) out of the cases of which pharyngeal culture was made after cefadroxil administration. Haemophilus influenzae was detected newly after the administration in 7 cases (58.3%) out of these 12 cases. Bacteriological efficacy was obtained in 5 cases of acute respiratory tract infection of which pathogen was considered to be Haemophilus influenzae. No microbial substitution was noticed in these 5 cases. As to the side effects of cefadroxil administration, only a slight diarrhea was observed in 2 cases.

[Studies of the real state of antibiotic consumption at an university hospital. Study in the pediatric department (author's transl)]

Antibiotic use at the Department of Pediatrics, Teikyo University Hospital was studied from 1974 to 1978, during which period a marked change was observed in the antibiotic consumption of Japan on the whole. From the view point of net weight of antibiotics consumed, beta-lactam antibiotics have been increasing up to more than 90% of antibiotic consumption and then follow macrolides and aminoglycoside substances. Chloramphenicol which was once the top antibiotic prescribed, and tetracyclines which have not been our choice, both have become very minor antibiotics in our present prescription. More than 90% of oral antibiotics were prescribed for outpatients and more than 90% of injectable antibiotics were administered to outpatients. Concerning oral penicillins, major three were ACPC, ABPC and AMPC for these years and as to oral CEPs most of them was CEX. ABPC and the fixed combination of ABPC and penicillinase resistant penicillin, were the top choice among injectable penicillins and CEZ was the top among CEPs. Concerning aminoglycoside antibiotic SM and KM were preferred as antituberculosis drug, and GM and DKB as antipseudomonas drug which took the main role in place with CBPC and SBPC since 1976. The type of oral drug preferred by pediatricians for prescription was also investigated and dry syrup type was found to be the most important one for pediatrics use. In spite of a steady increase of our outpatients for these five years, there was observed a remarkable decrease in number of antibiotic prescriptions, namely from 8,223 in 1974 to 4,613 in 1978. The reason is esteemed due to our policy to restrict possibly the needless use of oral antibiotics.