感染症診療における化学療法の問題 : 抗菌剤の基礎とその使い分け

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There have been changes of pathogenic microorganisms (pathogens) and conditions of diseases in the field of obstetrics-and-gynecologic infections. Infections caused by weak-bacteria, i.e., opportunistic infections, have increased in the bacterial infections of genital organs. Increase of compromised hosts is one of the contributing factors to such increase. On the other hand, advance of chemotherapy plays a major role in the treatment of infections and many antibiotics including beta-lactam antibiotics (penicillins and cepharosporins), new quinolones and others have been introduced in the recent few years. When history of development of antibiotics and changes of pathogens in obstetrics-and-gynecologic infections are reviewed, it is noticeable that significance of gram negative bacilli (including anaerobic bacilli) has increased, and complicated infections (aerobes plus anaerobes) account for two thirds of the infections. Consequently, emphasis has been placed on the development of antibiotics which should be effective for these pathogens, and beta-lactam antibiotics such as penicillins and cepharosporins are the main flow of the recent antibiotics. However, in consideration of potentiated antibacterial activity and pharmacokinetics, new antibiotics of a little different usage and selectin from the prevailing ones are in demand. Thus, the contents of chemotherapy have been changed as well as the changes of pathogens. Antibiotics have specific mode of action and point of action respectively and they show respective characteristics in their pharmacokinetics (serum concentration, urinary excretion and transfer into genital tissues). For example, beta-lactams show favorable intragenital tissue transfer regardless of some differences in their half-lives, and effective concentrations well over MIC_<80> are available in each tissue in the accumulated susceptibility distribution of MICs in the majority of pathogens. This is also verified by AUC (Area Under the Curve) or by contact-time. Empirical therapy may be applied to the patients as the first step of chemotherapy. In this report, therapeutic principles for drug-seclection are described by diseases in genital and urinary-tract infections. Particularly, application and proper use of oral and injectable drugs are reported mainly on cepharosporins (the first to third generations and thereafter) and, furthermore, significance in use and problems of new quinolones and the third-generation cephalosporins are reported. Also, unsuccessful factors (short-term administration or administration of a drug to unsusceptible disease) and timing for discontinuing treatment are reviewed. In the combination therapy of antibiotics, application criteria (such as infections caused by resistant pathogens) and practical cases (such as combination of beta-lactam and aminoglycoside, and beta-lactam and beta-lactamase inhibitor) are reported. In addition, therepeutic principles for perinatal infections and suitable drugs for STD (Chlamydia infections, etc.) and MRSA infections are mentioned. Post-operative administration of antibiotics for prophylaxis should be considered under specific criteria.
1989-08-01

感染症診療における化学療法の問題 : 抗菌剤の基礎とその使い分け

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