Experimental studies on the use of a cushioned plate for internal fixation

Internal fixation is widely used in the operative treatment of fractures, but various problems, such as local osteoporosis, may occur when living bone is fixed with a rigid metal plate. We propose a new method of immobilisation, which we have termed "cushioned plate fixation", in an attempt to solve some of these problems. Cushioned plate fixation involves a silicone rubber cushion placed between the steel plate and the bone. On the basis of data obtained from animal experiments in vivo and mechanical tests in vitro, we conclude that the cushion is effective in preventing osteoporosis without decreasing the strength of fracture fixation. We believe that this method might improve the mechanical biocompatibility of plate fixation.

Primary structure of human pancreatic alpha-amylase gene: its comparison with human salivary alpha-amylase gene

We have determined the entire structure of the human pancreatic alpha-amylase (Amy2) gene. It is approx. 9 kb long and is separated into ten exons. This gene (amy2) has a structure very similar to that of human salivary alpha-amylase (Amy1) gene [Nishide et al. Gene 41 (1986a) 299-304] in the nucleotide sequence and the size and location of the exons. The major difference lies in the fact that amy1 has one extra exon on the 5' side. Other differences are at the 5' border of exon 1 and the 3' border of exon 10. The close similarity of these two genes, as compared with mouse pancreatic and salivary amylase genes, suggests that during evolution, the divergence into the two amylase genes may have occurred after the divergence of mice and man.

[Production of enzymes and enzyme inhibitors in neoplastic tissues]

The mechanisms of ectopic enzyme and enzyme inhibitor-production in neoplastic tissues were investigated. No evidence was obtained to suggest any difference in the structural genes of amylase-producing tumors and normal lymphocytes. mRNA sequence coding for amylase precursor in tumor tissues was identical to that of salivary amylase, suggesting that the amylase in amylase-producing tumors was identical to, or closely resembled the amylase in salivary gland. High incidence of elevation of serum pancreatic secretory trypsin inhibitor (PSTI) was observed in patients with various malignant tumors. PSTI-positive malignant cells were also frequently found in malignant tissues. A comparison of human PSTI mRNA sequence with mouse epidermal growth factor (EGF) mRNA sequence showed that they were 46% homologous. Human PSTI stimulated [3H]thymidine incorporation into DNA in human fibroblasts at concentrations present in human serum.

[Effect of aztreonam on bacterial flora in human feces]

Aztreonam (AZT), a new injectable monobactam antibiotic, was administered to 7 healthy male volunteers, aged 21-28 years (23 years, on average) and weighing 60.5-87.0 kg, (69.5 kg, on average) by one shot intravenous injection of 1,000 mg twice a day for 5 days. The effect of AZT on the fecal flora was studied 3 days before administration, on the day of the initiation, 3 and 5 days (end of the administration course) after the initiation, and 3, 5 and 10 days after the end of the administration. Fecal concentration of AZT was also studied. Also, fecal concentration and recovery rate of AZT in 4 healthy male volunteers aged 23-31 years (26 years, on average), weighing 59.5-70.5 kg (65.6 kg, on average) were measured by injecting 1,000 mg of AZT by intravenous injection only one time. Susceptibility of the bacteria isolated from the 7 cases receiving consecutive dosage to AZT, cefmetazole (CMZ), latamoxef (LMOX), cefoperazone (CPZ) and ceftazidime (CAZ) as well as side effect and laboratory values were examined with the following results. In the fecal flora, the population of Enterobacteriaceae on average was 10(7) cells/g feces on the day of the initiation and decreased by 2 logarithms to 10(5) cells/g 3 days after the initiation, 10(5) cells/g feces 5 days after the initiation with no bacterial isolation in 2 cases, 10(7) cells/g feces on 3 and 5 days after the end of administration respectively with recovery of the population to the average population on the day of the initiation. However, it increased 10 days after the end of administration with the population of 10(9) cells/g feces due to the isolation of one 10(10) cells/g feces, which was an increase by 2 logarithms as compared with average population before the administration. It was also higher than the average population 3 days before the initiation of administration. Temporal decrease or disappearance of the bacteria were noted by the administration of AZT. As to other cases of Gram-negative bacilli, Pseudomonas sp. was detected from only 2 cases 3 days before the initiation of administration and on the day of the initiation, but there was an increase to 4 and 5 cases 3 and 5 days after the initiation respectively. Number of isolation returned to 2 cases, 3, 5 and 10 days after the end of administration respectively and it was same as the number before the initiation of administration.(ABSTRACT TRUNCATED AT 400 WORDS)

[Basic and clinical trials of aztreonam in the field of pediatrics]

Serum and urinary concentrations and recovery rates of aztreonam (SQ26,776, AZT), a newly developed antibiotic, were studied for a total of 20 pediatric cases by one-shot intravenous injections of 10, 20 and 40 mg/kg to 3, 4 and 3 cases, respectively, and by intravenous drip infusion of 10, 20 and 40 mg/kg to 3, 4 and 3 cases for 1 hour, respectively. Clinical and bacterial effects of AZT were studied by administering 76.7 mg/kg per day on average for a total of 36 cases of tonsillitis (6), pneumonia (13), otitis media and pneumonia complication (1), pleurisy (1), sinusitis (1) and UTI (14). The above daily dose was given t.i.d. (9 cases) or q.i.d. (27 cases), by intravenous drip infusion for 30 minutes for one t.i.d. case and by one-shot intravenous injection for 7 days for the remaining 35 cases. Also, side effect and laboratory values were examined for 43 cases including 7 dropouts. Serum concentration of AZT in 10 pediatric cases were measured by dosing 10, 20 and 40 mg/kg by one-shot intravenous injection to 3, 4 and 3 cases, respectively. In every dosage group, the serum concentrations were highest 5 minutes after the intravenous injection with average values of 91.0, 174.0 and 175.3 mcg/ml, respectively. Dose response was observed between 10 mg/kg dose group and 20, 40 mg/kg dose groups, but it was not between 20 mg/kg group and 40 mg/kg group. This was considered to be attributable to the individual case-fluctuations in the 2 groups and to a high concentration case of 240.0 mcg/ml in the 20 mg/kg group. Half-life of each dosage group was 1.55, 1.65 and 1.93 hours. Serum concentrations of AZT in 10 pediatric cases at the dosage level of 10, 20 and 40 mg/kg for 3, 4 and 3 cases, respectively, by 1 hour intravenous drip infusion were highest at the end of the administration with average values of 95.7, 126.0 and 170.7 mcg/ml, respectively. There was a dose response among the 3 groups and the half-life of them were 1.02, 1.41 and 2.48 hours, respectively. A longer half-life of the 3rd group with 40 mg/kg administration than the other 2 groups was due to 1 particular case of 4.44 hours with unknown cause of such an exceptional extension.(ABSTRACT TRUNCATED AT 400 WORDS)

[Fundamental and clinical studies on ceftizoxime suppositories in children]

The peak levels of serum ceftizoxime (CZX) after a single rectal administration of CZX-S at doses of 125 and 250 mg in 157 pediatric patients were occurred at 21 approximately 25 minutes in pediatric patients aged less than 1 year and over than 7 years, at 16-20 minutes in 1-3 years patients, at more than 26 minutes in 4-6 years patients. They were 9.45, 9.58, 11.71, 12.43 mcg/ml, respectively. The mean highest levels of serum CZX were 8.56, 10.66, 12.50 mcg/ml after the administration of CZX-S as less than 10.0, 10.1-15.0, 15.1-20.0 mg/kg dose respectively, all of which were occurred at 21-25 25 minutes. A close dose response was observed. The pain of insertion was not observed in any cases. The discharge of melted suppository or defecation after administration was observed in 15.2% of total 184 cases, which was noticed more frequently in the lower aged children. There was no influence by dose. Clinical effects of CZX-S were studied in 72 pediatric patients with various infections. CZX-S was administered rectally at the mean daily dose of 41.0 mg/kg divided into 3 or 4 times for 6 days. Clinical responses were excellent in 46 cases, good in 24 cases, fair in 2 cases. The efficacy rate was 97.2%. Regarding side effects, the pain of insertion was noted in 2 cases (2.8%), diarrhea in 6 cases (8.3%), the elevation of eosinophil in 1 case (1.7%). Bacteriologically, 23 strains (92.0%) out of 25 strains isolated from the patients were eradicated.

Studies of D-penicillamine on strain variability and lymph node cellularity in adjuvant arthritis

Experiments were performed in order to ascertain the action of D-penicillamine (PA) on adjuvant arthritis (AA) in rats and to develop a quantitative evaluation method for PA-like drugs, using Lewis, SD, and Wistar rats. Rats were inoculated in the tail with 0.6 mg of Mycobacterium butyricum suspended in 0.1 ml of liquid paraffin. PA apparently induced enhancement of arthritis only in Lewis rats with a good reproducibility. The enhancing effect of PA was seen when it was administered during the period from day -7 to day -1, from day 0 to day 6, or from day 14 to day 20. In control group of Lewis and Wistar rats, adjuvant caused a rapid increase in the cell number of lymph nodes just after the inoculation, and also a marked increase in spleen cells coinciding with the development of arthritis. In PA-treated Lewis rats, the cell numbers of lymph nodes and spleen significantly surpassed those of control rats. However, PA induced no difference from control in Wistar rats, which were not sensitive to PA treatment during the course of arthritis. These results indicate that AA in Lewis rats is a good model for evaluating the activities of PA-like drugs and that PA may affect lymphocytes in lymph nodes and spleen and induce severer arthritis in Lewis rats.

[Fundamental and clinical studies of aspoxicillin in the pediatric field]

Aspoxicillin (ASPC), a new semisynthesized penicillin, was administered to 20 children; by one shot intravenous injection in the doses of 10, 20 and 40 mg/kg to each of 3 children, and by intravenous drip infusion in the doses of 20 and 40 mg/kg over a period of 1 hour to 8 and 3 children, respectively, and the serum levels, urinary levels and recovery rates were determined. ASPC was administered to 1 patient with tuberculous pleurisy in the dose of 20 mg/kg by one shot intravenous injection, then the thoracic fluid level and serum level were determined. In addition, ASPC was administered to 3 children with tonsillitis, 3 with bronchitis, 40 with pneumonia, one each for pleuropneumonia, pleurisy, lung abscess, scarlet fever, staphylococcal scalded skin syndrome and purulent lymphadenitis and 2 with UTI (total 54 children), in the mean dose of 81.4 mg/kg/day t.i.d. (12 children) or q.i.d. (42 children) by one shot intravenous injection for 6 days on the average, and clinical effectiveness and bacteriological response were evaluated in these cases, and adverse reactions and abnormal laboratory findings were examined in the 60 cases which included 6 drop-out cases. After the administration of ASPC to 9 children; 10, 20 and 40 mg/kg to each of 3 children, by one shot intravenous injection, the mean serum levels reached to the peak of 58.4, 147.0 and 221.0 mcg/ml, respectively, in 5 minutes. The mean half-lives were 1.03, 1.01 and 1.23 hours, and the mean areas under the curve (AUCs) were 44.9, 94.1 and 192.9 mcg X hr/ml, respectively. A dose response was seen among the 3 dosage levels. After the administration of ASPC to 11 children; 20 and 40 mg/kg to 8 and 3 children, respectively, by intravenous drip infusion over a period of 1 hour, the mean serum levels reached to the peak of 58.2 and 114.0 mcg/ml, respectively, on completion of the administration. The mean half-lives were 1.22 and 1.09 hours, and the mean AUCs were 109.4 and 181.7 mcg X hr/ml, respectively. A dose response was observed between the 2 dosage levels. In the above mentioned each 3 cases receiving one shot intravenous injection in the dose of 10, 20 and 40 mg/kg, the mean urinary levels of ASPC reached to the peak of 1,000.0, 2,300.0 and 4,350.0 mcg/ml, respectively, at 0 approximately 2 hours after the administration, and the urinary recovery rates during the first 6 hours were 66.1, 66.5 and 56.9%, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

[Effects of KS-R1 (ampicillin suppository) and ampicillin oral dosing on fecal flora of children]

A newly developed product, KS-R1 (a suppository containing 250 mg potency of ampicillin (ABPC)), was given to 7 children (5 boys and 2 girls) ranging from 4 years and 5 months to 8 years and 10 months in age, 3 times a day (average daily dose, 62.4 mg/kg) for 5 days. As a control, the same amount of ABPC dry syrup was given orally to 7 children (4 boys and 3 girls) ranging from 2 years and 8 months to 7 years and 7 months in age, 3 times a day (average daily dose, 55.3 mg/kg) for 5 days. The effects of these 2 preparations on the bacterial flora of the feces were investigated, and concentrations of ABPC in the feces and sensitivities of the isolated strains to ABPC were determined. The results were as follows. As for Gram-negative bacilli in the feces from children given KS-R1, there was no change in Escherichia coli, Klebsiella sp., Citrobacter sp. and Enterobacter sp. which were isolated from many children 3 days after the end of treatment, but they did not show any constant pattern of change in mean number. Other species did not show any pattern of increase in the number of children from whom they were isolated, or in the number of bacteria during the course after the beginning of treatment. The total number of bacteria identified as Enterobacteriaceae was at the level of 10(8) cells/g on any day of examination. Of Gram-negative bacilli other than Enterobacteriaceae, Pseudomonas sp. showed no constant pattern of change in number. On the other hand, of Gram-positive bacteria, there was no constant pattern of change in the number of Staphylococcus aureus, Coagulase-negative Staphylococci began to be isolated from many children 5 days after the beginning of treatment and were isolated from all children 5 days after the end of treatment, but there was no tendency for the mean number to increase. Enterococcus sp. was not isolated from 3 children 3 days after the beginning of treatment, and was decreased in number by one order in 3 out of other 4 children as compared with before-treatment. However, this species was isolated from all children 3 days after the end of treatment, and the mean number of bacteria was similar to that before-treatment although the number of bacteria was different in individual children.(ABSTRACT TRUNCATED AT 400 WORDS)

[Fundamental and clinical studies of cefminox in children]

Cefminox (CMNX, MT-141), a newly developed injectable cephem antibiotic, was administered intravenously as one shot injection at 3 different dosages of 10, 20 and 40 mg/kg to 9 children; for each dose level 3 children were used. In these children serum and urinary concentrations as well as recovery rates were determined. In addition, in order to determine clinical and bacteriological efficacies of CMNX, it was used in the treatment of 37 cases of various infections consisting of 2 cases of acute tonsillitis, 1 case of acute tonsillitis associated with otitis media, 1 case of acute bronchitis, 1 case of chronic bronchitis, 20 cases of pneumonia, 1 case of pneumonia associated with otitis media, 8 cases of urinary tract infections, 2 cases of purulent lymphadenitis and 1 case of gluteal abscess. The drug was administered intravenously as one shot injection at a mean daily dosage of 76.6 mg/kg, in 4 divided doses in most cases, for a mean period of 6 days. Finally, in 43 cases added of 6 drop out cases which were included in analysis of efficacy side effects and abnormal laboratory findings were examined. The following results were obtained. In 9 cases, which received CMNX at 3 different dosages of 10, 20 and 40 mg/kg for 3 cases each intravenously as one shot injection, mean serum concentrations reached the peaks of 109.4, 218.1 and 357.1 mcg/ml at 5 minutes after injection, respectively, showing dose response relation. The mean half-lives were 1.74, 1.62 and 1.84 hours, respectively. The mean concentrations of CMNX in urine in the same cases as used for determinations of serum concentrations were highest during the 0 approximately 2 hours period, reaching 1,582, 3,304 and 4,618 mcg/ml at the respective doses. The mean recoveries within the first 6 hours were 82.8, 69.8 and 81.3%, the rate for 20 mg/kg group being lower than those obtained for the other groups. This is possibly due to 1 case which showed unusually low recovery rate of 44.4%. When this case is excluded, the recovery rates became similar for all groups. As to clinical results, responses rated as good or higher were obtained for 91.9% of the cases (34 cases/37 cases), with high efficacy rate. No side effects were seen in 43 cases included of drop out cases.(ABSTRACT TRUNCATED AT 400 WORDS)

[Experimental and clinical trials of BRL 25000 (clavulanic acid-amoxicillin) granules in the field of pediatrics]

MICs of BRL 25000, a combination of a newly developed beta-lactamase inhibitor CVA and AMPC in the ratio of 1 to 2, were determined against a number of bacterial strains and compared with those of AMPC, CVA, CEX and CCL. The 98 bacterial strains tested included 2-S. aureus, 23-H. influenzae, 25-E. coli, 22-K. pneumoniae and 26-P. mirabilis. In pharmacokinetic studies, BRL 25000 medium granules were administered to groups of 3 male subjects, aged between 7 years 8 months and 9 years 5 months, at doses of 10, 15 and 20 mg/kg, 2 hours after a meal. The resultant serum and urine concentrations and drug recoveries were measured. Furthermore, BRL 25000 was administered to a total 43 patients (2-pharyngitis, 8-tonsillitis, 3-bronchitis, 2-pneumonia and 28-urinary tract infection) whom clinically evaluable. An average daily dosage of 45.3 mg/kg was given, in 3 or 4 divided doses, for a period of 8 days on average. Clinical and bacteriological effects as well as side effects were studied. In the microbiological studies on 98 clinical strains, including beta-lactamase negative bacteria, BRL 25000 showed MICs against the Gram-positive cocci (2-S. aureus) superior to the other 4 drugs at inoculum sizes of 10(8) and 10(6) cells/ml. For the Gram-negative bacilli, against H. influenzae at inoculum sizes of 10(8) and 10(6) cells/ml, BRL 25000 was inferior in the small MIC range but superior in the large MIC range to AMPC, and was superior to the other 3 drugs. Against E. coli at an inoculum of 10(8) cells/ml, BRL 25000 showed antibacterial activity next to AMPC and CCL whilst at an inoculum of 10(6) cells/ml, it was inferior in the small MIC range but superior in the large MIC range to AMPC and CEX and was inferior to CCL but superior to CVA. Against K. pneumoniae at an inoculum of 10(8) cells/ml, BRL 25000 was equal to AMPC, CVA and CEX but inferior to CCL, whilst at an inoculum of 10(6) cells/ml, it was inferior to CCL but superior to the other 3 drugs. Against P. mirabilis at inoculum sizes of 10(8) and 10(6) cells/ml, BRL 25000 was inferior in the small MIC range but equal or superior in the large MIC range to AMPC, and was superior to CVA and CEX.(ABSTRACT TRUNCATED AT 400 WORDS)

[Effect of BRL 25000 (clavulanic acid-amoxicillin) on bacterial flora in human feces]

BRL 25000 (187.5 and 375 mg tablets), a formulation of CVA-K and AMPC in the ratio of 1:2, and AMPC (as control drug) were administered to healthy volunteers, aged 20 approximately 28 years and weighing 60 approximately 85 kg (68.8 kg, on average). Each drug was administered 3 times a day (after meals) for 5 days and the volunteers were separated into 3 groups of 4 subjects each. The effect on the fecal flora was studied before dosage, during administration (day 3 and 5) and day 3 and 5 after the administration course was completed. Studies were undertaken to isolate C. difficile on the last day of administration and 3 and 5 days after administration had ceased. Fecal concentrations and the susceptibility of the isolates to AMPC, CVA-K and BRL 25000 were measured. Side effects and laboratory findings were studied. The results obtained were as follows: 1. In BRL 25000 (187.5 mg X 3/day) group, the population of E. coli was on average, 1 X 10(6) approximately 9 X 10(6) cells/g feces before initiation of administration and it increased by 2 logarithms 3 and 5 days after initiation of administration. By 3 and 5 days after end of administration, the E. coli population was similar to the initial population. The population of Klebsiella sp. was 1 X 10(6) approximately 9 X 10(6) cells/g feces on average before commencement of dosage and it increased by 2 logarithms 3 days after initiation of administration but there was no consistent change in the Klebsiella sp. population thereafter. The Enterobacter sp., population was not consistent neither was the population of other Enterobacteriaceae. In total, the mean Enterobacteriaceae population was 1 X 10(7) approximately 9 X 10(7) cells/g feces before initiation of administration and increased by 2 logarithms 3 days after initiation of administration, and then returned to the initial level 5 days after end of administration. No consistent changes in population were noted for the other Gram-negative bacilli. The Staphylococcus sp. population was 1 X 10(6) approximately 9 X 10(6) cells/g feces on average before initiation of administration. This organism was detected in only 1 case 3 days after initiation of administration and in another 5 days after initiation of administration, thereafter, the population was similar to the initial population.(ABSTRACT TRUNCATED AT 400 WORDS)

[Clinical trials of BRL 25000 (clavulanic acid-amoxicillin) granules on skin and soft tissue infections in the field of pediatrics]

BRL 25000 is a combination of a newly-developed beta-lactamase inhibitor clavulanic acid (CVA) and amoxicillin (AMPC) in the ratio of 1 to 2. The drug, as medium granules, was administered to a total of 92 pediatric patients, ranging in age from 1 month to 13 years and 2 months, with cutaneous/soft tissue infections (70 impetigo, 6 furuncle, 7 phlegmon, 6 abscess and 3 cases of lymphadenitis). It was found subsequently that 2 of the 70 impetigo cases had received topical antibiotic medication and these were excluded from clinical evaluation to give a total of 90 evaluable cases. The daily dosage of BRL 25000 ranged from 23.7 to 75.0 mg/kg, given in 3 or 4 divided doses (average 48.5 mg/kg) and the duration of treatment was for 3 to 13 days (average 6 days). Clinical isolates of S. aureus from the above cases were examined for beta-lactamase production and their susceptibility determined to the 5 antibiotics BRL 25000, AMPC, CVA, cephalexin (CEX) and cefaclor (CCL). The drugs' clinical effects on the various diseases, bacteriological effects and side effects were also studied. At an inoculum of 10(8) cells/ml, major MICs of BRL 25000, AMPC, CVA, CEX and CCL against 71 strains of S. aureus, including beta-lactamase negative ones, were 3.13 mcg/ml, 12.5 mcg/ml, 50 mcg/ml, 12.5 mcg/ml and 12.5 mcg/ml, accounting for 60.6, 38.0, 49.3, 38.0 and 43.7% of the strains respectively, whilst at an inoculum of 10(6) cells/ml, major MICs were 1.56 mcg/ml, 3.13 mcg/ml, 25 mcg/ml, 6.25 mcg/ml and 3.13 mcg/ml, accounting for 57.7, 33.8, 83.1, 50.7 and 54.9%, respectively. It was noted that all drugs tended to show smaller MIC values as the inoculum size was reduced to 10(6) cells/ml and that BRL 25000 showed the most potent antibacterial activity of all 5 drugs.(ABSTRACT TRUNCATED AT 400 WORDS)

[Fundamental and clinical evaluation of ceftriaxone in the pediatric field]

Fundamental and clinical evaluation on ceftriaxone (Ro 13-9904, CTRX), a newly-developed injectable cephem antibiotic was performed as follows. The serum and urine concentrations of CTRX as well as the urinary recovery rate were determined in 7 children at 3 different dose levels; 3 cases administered with 10 mg/kg, 3 with 20 mg/kg and 1 with 48 mg/kg by one shot intravenous injection. The concentration in the cerebrospinal fluid was determined in 1 case of purulent meningitis associated with bacteremia, administered by one shot intravenous injection with 47.6 mg/kg. CTRX was also examined in its clinical and bacteriological efficacies by one shot intravenous injection for 8 days on average in a mean daily dose of 46.5 mg/kg, divided into twice a day in 31 cases, 3 times in 1 case, and 4 times changed from twice in 1 case; in a total of 33 children consisting of 3 with tonsillitis, 1 with chronic bronchitis, 20 with pneumonia, 2 with purulent meningitis associated with bacteremia, 3 with urinary tract infections, 1 with osteomyelitis associated with phlegmon, 3 with purulent lymphadenitis. The adverse reactions and laboratory test values were examined in a total of 40 cases, i.e., the above-mentioned 33 cases plus the 7 drop-out cases in which the clinical efficacy could not be evaluated. The results were as follows. The serum levels of CTRX in 7 cases consisting of 3 administered with 10 mg/kg, 3 with 20 mg/kg and 1 with 48 mg/kg reached their peaks 5 minutes after one shot intravenous injection and the mean values of them were 93.6 mcg/ml, 143.0 mcg/ml and 558.0 mcg/ml, respectively, indicating the existence of a dose-response among these groups, while the half-life times were 4.41, 5.86 and 4.09 hours. Among the 7 cases examined in the urinary levels as well as the serum levels, the 3 cases administered with 10 mg/kg reached the mean peak of 334.0 mcg/ml 2 to 4 hours after administration, while another 3 cases administered with 20 mg/kg showed peaks of 793.0, 522.0 and 536.0 mcg/ml, respectively, 2 to 4 hours, 4 to 6 hours and 6 to 12 hours after injection; this dispersion being partly because of that the urine specimen was unable to be collected regularly every hour in this dose group. In the case administered with 48 mg/kg, urinary level reached the highest value of 6,100.0 mcg/ml from 0 to 2 hours.(ABSTRACT TRUNCATED AT 400 WORDS)

[Fundamental and clinical studies of sulbactam/cefoperazone in the pediatric field]

To 6 cases of children in 2 groups of 3 each, newly developed sulbactam/cefoperazone (SBT/CPZ) was given at 20 and 40 mg/kg by intravenous bolus injection, respectively, and the serum and urinary concentrations and recoveries of SBT and CPZ were determined. To 1 case of purulent meningitis, this drug was given at 40 mg/kg by intravenous bolus injection, and the cerebrospinal fluid and serum concentrations of SBT and CPZ were determined. Susceptibility tests to SBT/CPZ and CPZ of total 289 strains were conducted; Gram-positive cocci tested consisted of 26 S. aureus strains, 20 S. pyogenes strains and 21 S. pneumoniae strains, and Gram-negative bacilli consisted of 24 H. influenzae strains, 22 E. coli strains, 26 K. pneumoniae strains, 24 E. cloacae strains, 21 E. aerogenes strains, 19 Citrobacter sp. strains, 20 S. marcescens strains, 23 P. mirabilis strains, 23 indole-positive Proteus sp. strains and 20 P. aeruginosa strains. SBT/CPZ was given to total 43 cases at a mean daily dosage of 80.4 mg/kg, in 3 or 4 divided doses (6 cases in 3 and 37 cases in 4), 1 case receiving the drug by drip infusion over 30 minutes (in 3 divided doses) and all the other 42 cases by intravenous bolus injection, for 7 days on an average. They consisted of 2 cases of tonsillitis, 1 case of otitis media, 1 case of otitis media associated with mastoiditis, 30 cases of pneumonia, 1 case of suspected septicemia, 1 case of purulent meningitis, 5 cases of urinary tract infection, 1 case of purulent lymphadenitis and 1 case of submaxillaritis. And the clinical and bacteriological effects were evaluated. Also, side reactions and laboratory examinations for abnormal values due to administration of this drug were made on 47 cases including 4 drop-outs. The following results were obtained: After administration of this drug to 2 groups of 3 children each at 20 and 40 mg/kg by intravenous bolus injection, mean serum concentrations of both SBT and CPZ reached the peaks in 5 minutes; SBT levels were 60.9 and 124.7 micrograms/ml for the 2 groups and CPZ levels were 105.0 and 214.1 micrograms/ml, respectively. In either group, CPZ levels were 1.7 times as high as SBT levels, and there was observed a dose-response in both. In the 20 mg/kg group, mean half-lives of SBT and CPZ were 0.96 and 1.24 hours, respectively, and in the 40 mg/kg group, they were 1.01 and 1.32 hours, CPZ values tending to be longer.(ABSTRACT TRUNCATED AT 400 WORDS)

Establishment and characterization of adult T-cell leukemia virus-containing B-cell lines derived from peripheral blood of adult T-cell leukemia patients

B-cell lines which showed predominantly surface IgA kappa immunoglobulins were established from each of seven adult T-cell leukemia (ATL) patients. ATL virus proviral DNA was found in five of the lines. Though the chromosomal analysis of the B-cell lines yielded normal results, fresh leukemic T-cells showed chromosome abnormalities.

Chromosome abnormalities of leukemia cells in adult patients with T-cell leukemia

Chromosomes of 30 patients with adult T-cell leukemia were analyzed. Chromosome abnormalities were found in all the patients examined. The modal chromosome number of abnormal cells was hypodiploid in 2 patients, diploid in 14, and hyperdiploid in 9. The remaining 5 patients had bimodal chromosome numbers (diploid and hyperdiploid modes). Although all the patients showed various numerical or structural chromosome abnormalities, they also had common chromosome abnormalities. Aberrations of chromosome 1 were noted in 20 of the 30 patients, aberrations of chromosome 3 were seen in 20, trisomy 6 or 6q- was found in 17, aberrations of chromosome 10 were noted in 16, aberrations of the long arm of chromosome 14 were seen in 9, and trisomy 18 was seen in 7. There was no particular relationship between the difference in clinical symptoms and disparity in chromosome abnormalities.

Transformation of ATLA-negative leukocytes by blood components from anti-ATLA-positive donors in vitro

Anti-ATLA-positive blood components transformed healthy human leukocytes in vitro. Blood components examined were packed red cells, whole blood, platelet concentrate and fresh frozen plasma. Leukocytes present in anti-ATLA-positive blood components such as packed red cells, whole blood and platelet concentrate easily transformed anti-ATLA-negative leukocytes. Co-culture in fresh frozen plasma, however, did not transform recipient leukocytes, and leukocytes of anti-ATLA-positive recipients proved refractory to transformation. The transformed cells were morphologically lymphoid, grew in suspension, and possessed normal recipient karyotypes except in the case of three platelet concentrates. A high proportion of all the transformed populations formed E-rosettes with neuraminidase-treated sheep erythrocytes. The cytoplasm of over 90% of each recipient was stained brilliantly with antibodies against ATLV-determined antigens. Electron microscopy of these transformed cells revealed many C-type virus particles in the extracellular space. Blood components, such as packed red cells, whole blood and platelet concentrate, containing leukocytes from anti-ATLA-positive donors, should be used cautiously to prevent the transmission on ATLV to anti-ATLA-negative recipients.

[Fundamental and clinical studies of ceftazidime in the pediatric field]

Ceftazidime ( CAZ ), a newly-developed parenteral cephem antibiotic, was administered to 8 children; by one shot intravenous (i.v.) injection in the doses of 20 and 40 mg/kg each to 2 children, and by 30 minutes' i.v. drip infusion in the doses of 10 and 20 mg/kg each to 2 children, and the serum levels, urinary levels and recovery rates were determined. CAZ was also administered to 2 patients with purulent meningitis, one complicated with subdural abscess and the other with bacteremia, in the doses of 19.2 and 50.7 mg/kg, respectively, by one shot i.v. injection, and the CSF level of CAZ was determined. In addition, CAZ was administered to 2 children with acute bronchitis, 1 with chronic bronchitis, 37 with pneumonia, 3 with pleuropneumonia, 1 each for purulent meningitis, purulent meningitis accompanied with subdural abscess and purulent meningitis with bacteremia, 5 with urinary tract infections and 3 with purulent lymphadenitis (total 54 children), in the mean dose of 85.8 mg/kg/day mostly in 4 divided doses by one shot i.v. injection for 9 days on the average, and clinical effectiveness and bacteriological response were evaluated in these cases, and adverse events and abnormal laboratory findings were examined in the 66 cases which included 12 drop-out cases. 1. After the administration of CAZ to 4 children; 20 and 40 mg/kg each to 2 children, by one shot i.v. injection, the mean serum levels got to the peak of 115.8 and 199.5 mcg/ml, respectively, at 5 minutes. The results were good, showing dose response. The mean half-lives were 1.48 and 1.37 hours, respectively. After the administration of 10 and 20 mg/kg of CAZ each to 2 children by 30 minutes' i.v. drip infusion, the mean serum levels got to the peak of 58.5 and 80.0 mcg/ml, respectively, on completion of the administration, showing dose response. The mean half-lives were 1.06 hours in the former 2 cases, and 1.38 and 3.26 hours, respectively, in the latter 2 cases. The reason for the prolongation observed in 1 case was not clear. 2. In the above mentioned each 2 cases receiving one i.v. injection, the mean urinary levels got to the peak of 4,240 and 4,445 mcg/ml, respectively, at 0-2 hours after the administration , and the urinary recovery rates during the first 6 hours were high, 95.7% and 99.5%, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

[Clinical trials of cefmetazole for pneumonia and pyothorax caused by Staphylococcus aureus resistant to cefazolin]

Cefmetazole (CMZ), an antibiotic agent of the cephamycin group, is resistant to beta-lactamase and has a broad antibacterial spectrum covering Gram-positive cocci and Gram-negative bacilli. However, it has not been indicated for Gram-positive cocci. We examined its clinical, bacteriological and side effects in 2 infants with pneumonia and 2 with pyothorax, which had been suggested to be caused by CEZ-resistant and CMZ-sensitive Staphylococcus aureus or other inflammatory organisms by a disc sensitivity test, for 2 years and 3 months from January, 1981 to March, 1983. The patients aged 1 to 22 months, and a mean daily dose of 108 to 115 mg/kg was divided into 2 to 4 equal doses and injected into the vein at one shot for a mean fo 19 days. The following results were obtained: The clinical effect of CMZ was evaluated to be good in 1 and fair in 1 of 2 infants with pneumonia, and excellent in 1 and good in 1 of 2 with pyothorax. Bacteriologically, S. aureus was removed in an infant with pneumonia and in 2 with pyothorax. Bacteriological test was not conducted in the remaining 1 with pneumonia. No side effects were found in any cases. Eosinophilia appeared as an abnormal clinical test value in a case, but the number of eosinophils became normal after termination of the medication. As mentioned above, CMZ manifested an excellent clinical effect in infants with pneumonia or pyothorax caused by S. aureus although the number of the patients was small. From the results the antibiotic agent can be expected to be effective in these disease.

Seropositivity of a blood recipient from a donor with positive adult T-cell leukemia-associated antigens

A blood recipient, aged 66, was found to have positive adult T-cell leukemia-associated antigens (ATLA), approximately half a year after a transfusion. The donor's ATLA-antibody titer was 1: 640. Routine screening of blood donors for ATLA antibody was proposed.

Immunopharmacologic studies of D-penicillamine-L-cysteine disulfide

Effects of D-penicillamine-L-cysteine disulfide (P-C) on some immunological parameters were examined in normal and immunity-impaired mice and rats. P-C enhanced the DNA synthesis in concanavalin A-stimulated mouse spleen cell cultures in vitro. In vivo, administration of P-C produced either enhancement or depression of plaque forming cell (PFC) response and delayed type hypersensitivity (DTH) to sheep red blood cells (SRBC) in low responder mice to SRBC, depending on the dose of P-C. P-C restored the impaired PFC response in hydrocortisone-pretreated mice. The enhancing effect of P-C was not shown in high responder mice to SRBC, but an inhibiting effect was observed. P-C inhibited the suppressor cell induction on PFC response in mice immunized with a supraoptimum dose of antigen. In adjuvant arthritic rats, P-C induced severe arthritis by eliminating the suppressor cells regulating this disease process. The relevance of these findings and mode of action of D-penicillamine in rheumatoid arthritis is discussed.

[Experimental and clinical evaluation of latamoxef in newborn and premature infants]

Latamoxef (LMOX) was administered as a one-shot intravenous injection of 10 mg/kg or 20 mg/kg to 28 newborn and immature infants of 1 to 28 days of age. For 6 hours following the administration, the concentrations of the drug in the plasma and in the urine were monitored and the urinary recovery rate was determined. In addition, 17 patients, consisting of newborns, immature infants and suckling infants, aged 0 days to 2 months and diagnosed as having various bacterial infections, were also treated with LMOX; the mean daily dosage was 103 mg/kg, administered in 2 to 6 divided doses as one-shot intravenous injections for an average duration of 11 days. These patients were subjected to the analysis for the clinical efficacy and bacteriological efficacy of the therapy. Furthermore, with the inclusion of 35 drop-out cases, a total of 52 patients was investigated for the occurrence of side effects by the LMOX therapy. The findings of these studies are summarized below. The patients were divided into 5 groups on the basis of age: 3 days old or less, 4--7 days, 8--14 days, 15--21 days and 22--28 days. Only in the 8--14 day-old group administered LMOX at 20 mg/kg, the maximum mean plasma concentration of the drug occurred at the time of 15 minutes postadministration, although some individuals showed peaks at 5 minutes. In all of the other age groups, for both the 10 and 20 mg/kg dosages, the maximum plasma concentration of LMOX occurred 5 minutes postinjection. In each of the age groups, a dose response was seen between the 2 dosage levels. However, a comparison of each group and control infants in terms of the LMOX plasma concentration at 30 minutes after injection revealed that the concentrations in the patients in this study were low. In terms of the half-life of the drug at the 2 dosage levels, both the mean and individual values in each of the age groups were longer than the half-lives in control infants. This tendency was especially marked in the case of infants 7 days of age or less. The values for the AUC also tended to be larger in the younger patient groups. A good level of LMOX was detected in the urine during each of the 0--2, 2--4 and 4--6 hour periods following administration.(ABSTRACT TRUNCATED AT 400 WORDS)

[Clinical effect of cefroxadine on surgical infections]

Cefroxadine (CXD), an orally active cephalosporin antibiotic, has a broad spectrum and a bactericidal action. The efficacy of CXD in the surgical field was investigated and the following results were obtained. CXD was administered to 31 cases in all; 13 cases with mastitis, 9 with wound infection, 4 with infected atheroma, 3 with periproctal abscess and 2 with phlegmon, respectively. The daily dose was ranged from 750 mg to 1,500 mg. Clinical effects were good in 27 cases and fair in 4 cases, and the effective rate was 87.1%. As to side effects, a slight diarrhea was observed in 1 case, but the symptom was disappeared after 2 days without a special treatment.

[Experimental study of an ampicillin suppository (KS-R1) in adults and children]

KS-R1, a new rectal suppository of ampicillin (ABPC) sodium, was compared with oral and parenteral ABPC in terms of absorption and excretion in childish patients and healthy adult male volunteers. In addition, the irritation of KS-R1 to the rectum was studied. 1. Eight healthy adult male volunteers received 250 mg (potency) of KS-R1 rectally and 125 mg of ABPC intravenously in a cross-over study. Then, 4 of them were given intramuscularly 250 mg of ABPC, and 3 of the remaining 4 volunteers were given 250 mg of ABPC orally. The rectal administration of 250 mg of KS-R1 resulted in a mean peak ABPC plasma level (Cmax) of 2.6 mcg/ml at 30 minutes, and then ABPC levels declined with biological half-life (T2/1) of 0.55 hour. The peak time (Tmax) of occurrence after rectal dose of KS-R1 was earlier than that after oral dose of ABPC, and was equal to that after intramuscular dose of ABPC. Cmax after rectal dose of KS-R1 was equal to that after the oral dose, and was about 40% of the value attained with the intramuscular dose. Urinary recovery of ABPC during 6 hours after rectal dose of KS-R1 was 24.0%, compared with 34.0% for the oral dose, 59.6% for the intramuscular dose and 61.4% for the intravenous dose. The relative bioavailability of KS-R1, calculated on the basis of urinary recovery after intravenous administration of ABPC, was about 40%. 2. When KS-R1 (250 mg) was given to 2 adult volunteers 3 times daily for 5 days, no remarkable difference was found in plasma concentration and urinary recovery of ABPC. The pharmacokinetic parameters following the last administration were similar to those following a single administration of KS-R1. 3. KS-R1, oral ABPC and intravenous ABPC were administered at the dose of 125 mg (potency) to 5, 4 and 3 children and at the dose of 250 mg (potency) to 5, 3 and 3 children, respectively. Peak plasma level (Cmax) of ABPC after rectal administration of 125 mg and 250 mg of KS-R1 was reached in 15 minutes, indicating 4.8 and 7.1 mcg/ml, respectively. Peak time (Tmax) of ABPC after the rectal doses of KS-R1 was about 2 hours earlier than that after oral doses of ABPC. Cmax after KS-R1 was 3-4 times as high as that after the oral doses. Area under the curve (AUC) with KS-R1 was 1.38-1.55 times greater than that of oral ABPC, and about 24% of the values obtained with intravenous doses of ABPC. Urinary recoveries of ABPC rectal doses of KS-R1 were 30.4 to 45.6%, compared with 29.2 to 30.8% for the oral doses and 61.1 to 76.1% for the intravenous doses.(ABSTRACT TRUNCATED AT 400 WORDS)

[Clinical effects of an ampicillin suppository (KS-R1) in urinary tract infection of children]

Clinical effects of ampicillin suppository (KS-R1) were examined in 24 children (11 male and 13 female) aged from 5 months to 7 years 5 months with urinary tract infection. KS-R1 was rectally given to the patients at doses of average 45.6 mg/kg/day divided into 3 to 4 times for average 8 days. Clinical effectiveness was 95.8%. Bacteriologically, the eradication of isolated organisms was observed in 10 (71.4%) out of 14 cases, the decrease in 3 (21.4%) and the persistence in 1 (7.1%). The discharge of suppository within 5 minutes after insertion was observed in 8.7% of patients without diarrhea and in 6.9% of patients with diarrhea. The evacuation rate of the bowels within 10 minutes after insertion was observed in 5.9% of patients without diarrhea and in 41.9% of patients with diarrhea. It was suggested that the administration of KS-R1 to childish patients with diarrhea should be careful. As to the side effects, diarrhea was observed in 2 cases (7.1%) and the elevation of GPT and GOT in 1 case (3.6%).

[Experimental and clinical evaluation of an ampicillin suppository (KS-R1) in children]

Plasma levels of ampicillin (ABPC) after the single rectal insertion of KS-R1 at doses of 125 and 250 mg in 154 children reached a peak at 11 approximately 15 minutes in children of age less than 1 year old, at 16 approximately 20 minutes in children of 1 approximately 3 years, 4 approximately 6 years and more than 7 years old with the highest levels of 11.50, 8.69, 10.33 and 8.30 micrograms/ml, respectively. Highest plasma levels of ABPC were 6.48, 8.00, 12.32 and 17.83 micrograms/ml by the administration of KS-R1 at doses of less than 10.9 mg/kg, 11.0 approximately 15.9, 16.0 approximately 20.9 mg/kg and more than 21.0 mg/kg, respectively, with dose-dependent response which were observed at 11 approximately 15 minutes or 16 approximately 20 minutes. There was no difference of plasma levels between the administration of 125 and 250 mg of KS-R1. The pain of insertion was observed in 0.6% of total 167 cases, the feeling of defecation in 2.4% and the discharge of suppository or its dissolved material or defecation within 30 minutes after insertion in 12.6%, without the influence of patients ages and dosage level. These figures were almost the same as those after the insertion of other suppositories such as erythromycin suppository or antipyretic suppository. Clinical effectiveness of KS-R1 was examined in 51 childish patients with various infections. KS-R1 was rectally given to them at doses of average 41.6 mg/kg/day divided into 3 to 4 times for 7 days. All cases showed excellent and good effects. Bacteriologically, all pathogens which were isolated from 12 patients were eradicated.

[Clinical evaluation of josamycin for the treatment of Mycoplasma pneumonia in children]

Thirty-one strains of Mycoplasma pneumoniae were tested for drug sensitivity to both josamycin (JM) and erythromycin (EM), to evaluate the efficacy of JM for mycoplasmal pneumonia in children. In addition to the sensitivity tests of 31 M. pneumoniae strains against JM and EM, 50 patients, between the ages of 3 years 1 month and 13 years 3 months, suspected of suffering from mycoplasmal pneumonia were treated with 50 or 200 mg JM tablets at an average daily dose of 43.1 mg/kg t.i.d. or b.i.d. for an average period of 14 days; an additional 31 patients between the ages of 2 years 9 months and 11 years, suspected of suffering from this disease were treated with tablet or dry syrup of EM, with the exception of EM estolate, t.i.d. or b.i.d. at an average daily dose of 72.5 mg/kg for an average period of 15 days. Patients were selected in 37 and 22 mycoplasmal pneumonic patients respectively for JM and EM. Clinical and bacteriological effects, efficacy and side effects of the drugs on this disease were studied and the following results were obtained. Drug sensitivity test Of all 31 strains tested for JM sensitivity the populations which exhibited 0.125 mcg/ml were most abundant (18/31, 58.1%) and MIC pattern of all strains were distributed from 0.0313 to 0.125 mcg/ml. In the EM group, 61.3% (19/31) of the populations were sensitive at 0.015 mcg/ml, exhibiting the dominant distribution pattern and MIC range of all organism varied from 0.0078 to 0.0313 mcg/ml. Resistant strains were found to neither JM nor EM. EM was approximately 2 to 10 times more active than JM in MIC evaluation. Clinical effects of JM by daily doses Clinical effects relative to the daily dose were evaluated in 3, 7, 10 days after administration of drugs. The response was favorable, according to assessments of the attending doctors, in 96.7, 100% and 95.8% of the patient group given JM in a daily dose of 40-49 mg/kg, the group to which the largest number of patients belonged. Similar favorable results were obtained by the assessments of Evaluation Committee, showing 86.7, 96.7% and 100% of favorable response. Upon comparison, in the same interval, of these results with those of the groups given EM in a daily dose of 50 mg/kg, the group in which the largest number of patients were seen, there was no significant difference in the assessments either of the attending doctors or of the Evaluation Committee.(ABSTRACT TRUNCATED AT 400 WORDS)

[Clinical studies on cefadroxil in the field of pediatrics]

The newly developed cefadroxil (CDX) dry syrup in a mean daily dose of 32.9 mg/kg t.i.d. or q.i.d. was administered to children for a period of 8 days on the average; viz. a total of 64 cases consisting of 39 cases of tonsillitis, 2 of tonsillitis complicated with otitis media, 1 of bronchitis, 1 of pneumonia, 14 of scarlet fever, and 7 of urinary tract infections; and its clinical and bacteriological effects, and adverse reactions were examined, leading to the following results. 1. The clinical effects were "good" or "excellent" in any of 39 cases of tonsillitis, 2 of tonsillitis complicated with otitis media, 1 of pneumonia, 14 of scarlet fever, and 7 of urinary tract infections, and "fair" only in a case of bronchitis, showing the high efficacy of 98.4%. 2. The clinical effects by daily dose were compared only in the great cases of tonsillitis between the 2 daily dose groups of 30 mg/kg or below and 31 to 40 mg/kg, and both groups showed "good" or "excellent" results, but the latter group revealed that the excellent rate was greater by 20.8% than that of the former group. 3. The frequency of daily administration was 3 times or 4 times and the cases of 4 times administration were few in any disease. In comparison of clinical effects between the 3 times group and the 4 times group in the whole cases, no significant difference was observed between both groups but it is desirable to make the 4 times administration in view of the pharmacokinetics. 4. The bacteriological effects could be judged in 15 cases, namely bacteria were eradicated in 14 cases and unchanged in 1 case, showing a good result of the eradication rate as 93.3%. 5. No adverse reaction was observed and the laboratory test values showed eosinophilia in 7 cases (15.9%) and abnormal elevations of GPT in 1 case (4.5%), of GOT and GPT in 2 case (9.1%), of LDH in 1 case (4.8%) and of BUN in 1 case (4.8%), but 4 of the 7 cases with eosinophilia seemed attributable to underlying diseases or objective diseases. From the above it can be said that this preparation is a useful drug in mild bacterial diseases.

[Clinical trials of cefroxadine on skin and soft tissue infections in the field of pediatrics (author's transl)]

CXD was administered orally at an average dose of 28.6 mg/kg (18.3 approximately 42.3 mg/kg) for an average 6 days (3 approximately 12 days) to a total of 99 pediatric cases with skin and soft tissue infections (impetigo 89, abscess 7 and furuncle 3) ranging from 3 months to 9 years old. The drug was given twice to 4 times per day after meals. The clinical and bacteriological effects and adverse reactions of CXD as well as the susceptibility of the causative organisms against CXD and CEX were studied, and the results obtained are as described below: 1. According to judgement of the attending doctors, CXD had a high global efficacy rate of 90.9%. 2. Analysis of the attending physicians' evaluations of the clinical effects on impetigo revealed that a dose of CXD 20.5 approximately 30.4 mg/kg t.i.d. can produce satisfactory responses. 3. According to the assessments by Evaluation Committee, the global clinical effects after 3, 5 and 7 days were 81.4, 91.2 and 94.6%, respectively. This indicates that clinical responses increased with prolongation of the treatment period, viz. better responses obtained after 5 and 7 days. This suggests that a minimum of 5 days administration is required for treating these infections. 4. As for impetigo having the largest number of patients in this study, a dose of CXD 20.5 approximately 30.4 mg/kg per day seemed to produce satisfactory clinical effects. 5. As for dose per day, the t.i.d. regimen of CXD 20.5 approximately 30.4 mg/kg seemed to exhibit satisfactory clinical responses, as already mentioned. Because of quite a small number of patients on the q.i.d. regimen of higher doses, however, the question of whether the t.i.d. treatment with 20.5 approximately 30.4 mg is adequate or not should be determined by a comparative study between the q.i.d. and t.i.d. treatments. 6. As for bacteriological responses, a high global effect of 87.1% was obtained with CXD against S. aureus and S. pyogenes isolated from 74 and 1 cases, respectively. 7. As for impetigo with predominant number of cases, CXD was highly effective bacteriologically at a daily dose of 20.5 approximately 30.4 mg/kg t.i.d. As an appropriate comparative evidence with the q.i.d. treatment was lacking, however, therapeutic validity of the t.i.d. treatment could not be determined definitely. 8. Utility was evaluated by the attending physicians on the total 99 cases, and CXD showed as high as 88.9%. 9. There were neither non-compliances nor adverse reactions to this treatment. 10. CXD showed a distribution of antimicrobial activity similar to that of CEX, against 74 isolates of S. aureus with the MICs of CXD ranging from 1.56 to 25 mcg/ml and those of CEX ranging from 0.78 to 25 mcg/ml, with peak MIC being 3.13 mcg/ml for both drugs. As for S. pyogenes, only one isolate from the same species, CXD was antimicrobial activity at 0.2 mcg/ml and CEX was antimicrobial at 0.39 mcg/ml. The above findings suggest that CXD is highly effective against acute skin and soft tissue infections in pediatrics.