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A retrospective survey was performed comparing the annual rate of antimicrobial usage (1973 through 1978) and bacteria isolated from clinical specimens (1969 through 1978) at Nagasaki University Hospital with the annual rate of antimicrobial usage reported for Japan (FUJII R. 1979). Nagasaki University Medical Center has an average daily in-patient and out-patient population of approximately 790 and 640 respectively. A central clinical hospital laboratory processes all specimens obtained from in-patients as well as specimens from out-patients reffered to the Medical Center from community hospitals and private physicians.<BR>In 1973, approximately 70% of the bacteria isolated from clinical specimens was gram-negative bacilli belonging to the farnilies Enterobacteriaceas and Pseudomonadaceae. During this same time interval, the primary antimicrobial agents used were the penicillins (PCs) and cephalosporins (CEPs) with 100.9kg and 76.6kg prescribed respectively. Antimicrobial agents used to a lesser extent included; 20.3kg of chloramphenicol (CP), 14.1kg of macrolides (MLs)(primarily lincomycin and clindamycin), 10.8kg of aminoglycosides (AGs) and 3.2kg of tetracyclines (TCs).<BR>During the next six years, the use of both PCs and CEPs at Nagasaki University Medical Center increased such that in 1978 these two antimicrobial agents accounted for 88.2% of the antimicrobial agents administered. This was intermediate between the use of these two agents in Japan during 1978 (74.9%) and of Teikyo University Hospital during 1976 (92.0%).<BR>The use of CP and TCs declined during 1973 through 1978 from 20.3kg to 0.5kg and 3.2kg to 1.5kg respectively. The decline in the use of these two antimicrobial agents was comparable to that which occurred in Japan during this time interval. The annual rate of MLs and AGs use at Nagasaki University Medical Center was different from that reported for Japan. The use of MLs declined from 14.1kg in 1973 to 8.4kg 1975 but thereafter gradually increased to 21.1kg in 1978. The decline in the use of MLs from 1973 to 1975 was due to the recognition of the role of clindamycin in causing pseudomembranous colitis. In 1975, however, CP use was limited by the Japanese government and during this same time there was an increasing awareness of the importance of anaerobic bacteria in infections necessitating the increase use of MLs as substitutes for chloramphenicol therapy.<BR>The use of AGs displayed a similar trend as was seen with MLs: from 1973 to 1976 there was a decrease from 10.8kg to 5.9kg which followed by increase in 1978 to 7.3kg. The decline in the use of AGs was due to an increase in the use of injectable gentamicin, dibekacin, amikacin and tobramycia, all four which display antipseudomonal activity, in place of kanamycin and streptomycin which requite five to ten times more agent each dose. On the other hand, when flatoridin was prohibited from cal use in 1975 there was an increase in the use of oral kanamycin to treat intestinal infections thereby accounting for the increase in the use of AGs from 1975 through 1978.<BR>From 1973 through 1978 there was a decrease in the use of penicillin G, nalidixic acid, piromidic acid and thiamphenicol.
- 公益社団法人 日本化学療法学会の論文
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