H. Akita

A comparative clinical study of macrolide-sensitive and macrolide-resistant Mycoplasma pneumoniae infections in pediatric patients.

In recent years, the increased prevalence of macrolide-resistant Mycoplasma pneumoniae (MR-M. pneumoniae) has become a significant issue in Japan. We isolated 94 strains of M. pneumoniae, and determined the minimum inhibitory concentrations (MICs) of macrolides and other antimicrobial agents for these strains. We also performed a comparative clinical evaluation of macrolide efficacy for cases of MR-M. pneumoniae infections and cases of macrolide-sensitive Mycoplasma pneumoniae infections (MS-M. pneumoniae). Of the 94 isolates of M. pneumoniae, 64 (68.1%) were classified as MS-M. pneumoniae and 30 (31.9%) as MR-M. pneumoniae strains. The clinical study included an assessment of 47 pediatric cases of MS-M. pneumoniae and 22 pediatric cases of MR-M. pneumoniae. The patient demographics, such as sex, age, the period from the onset of the infection to the first examination, laboratory findings, diagnosis, and the severity of symptoms, showed no significant difference between the two study groups. However, the efficacy of macrolide treatment was 91.5% for MS-M. pneumoniae and 22.7% for MR-M. pneumoniae, a statistically significant difference (P < 0.01). Although M. pneumoniae infection is generally considered a treatable condition, the increasing prevalence of macrolide-resistant strains of M. pneumoniae has become a significant clinical issue in pediatric patients, and it is therefore necessary to give careful consideration to the appropriate antimicrobial therapy for MR-M. pneumoniae infection.

Neonatal meningitis caused by Streptococcus gallolyticus subsp. pasteurianus

We encountered a case of neonatal meningitis caused by Streptococcus gallolyticus subsp. pasteurianus. The patient was an 8-day-old boy. Gram staining of the cerebrospinal fluid (CSF) revealed gram-positive cocci in pairs or in short chains. In culture, γ-streptococcus-like colonies grew. The result of 16S rRNA sequence analysis identified S. gallolyticus subsp. pasteurianus. From these results, bacterial meningitis was diagnosed and, as a result of antimicrobial susceptibility testing, single-dose ampicillin therapy was given. Because inflammatory deterioration and spread was suspected from the CSF test results, this therapy was added by panipenem/betamipron. In response to his recovery, antibiotic treatment was stopped and the boy was discharged. This bacterium was classified as S. gallolyticus subsp. pasteurianus in the latest report in 2003. Since this change, there have only been a few cases of neonatal meningitis caused by this bacterium. Here we report this rare case.

Recent trends in pediatric bacterial meningitis in Japan – A country where Haemophilus influenzae type b and Streptococcus pneumoniae conjugated vaccines have just been introduced

To investigate the trends in incidence and the characteristics of bacterial meningitis in Japan where Haemophilus influenzae type b (Hib) vaccine and 7-valent pneumococcal conjugated vaccine (PCV7) were introduced in 2008 and 2010, respectively, which was 5-20 years after their introduction in western countries. The nationwide Japanese survey of pediatric and neonatal bacterial meningitis was performed in 2011 and 2012. We analyzed the epidemiological and clinical data, and compared the information obtained in the previous nationwide survey database. We also investigated the risk factors for disease outcome. In the 2011-2012 surveys, 357 patients were evaluated. H. influenzae, Streptococcus pneumoniae, Streptococcus agalactiae and Escherichia coli were the main organisms. The number of patients hospitalized with bacterial meningitis per 1000 admissions decreased from 1.31 in 2009 to 0.43 in 2012 (p < 0.001). The incidence of H. influenzae and S. pneumoniae meningitis also decreased from 0.66 to 0.08 (p < 0.001), and 0.30 to 0.06 (p < 0.001), respectively. Only 0-2 cases with Neisseria meningitidis were reported each year throughout 2001-2012. The median patient age was 10-12 months in 2001-2011, and became lower in 2012 (2 month old) (p < 0.001). The fatality rate for S. agalactiae is the highest (5.9% (11/187)) throughout 2001-2012 among the four organisms. Risk factors for death and sequelae were convulsions at onset, low CSF glucose, S. agalactiae etiology, and persistent positive CSF culture. Hib vaccine and PCV7 decreased the rate of bacterial meningitis. Earlier introduction of these vaccines may have prevented bacterial meningitis among Japanese children.

Rational use of oral antibiotics for pediatric infections

SummaryWe carried out a survey in Japan to investigate compliance among children given oral antibiotics in an outpatient setting. The results of our survey revealed that, in Japan, approximately one-quarter of patients did not take their full course of antibiotics. Reasons for unsupervised self-discontinuation included: (1) the parent or guardian judged the infection to be cured; (2) the child refused to take the drug; and (3) the appearance of side effects. Causative organisms often involved in respiratory infections experienced in outpatient medicine include pneumococci, streptococci, staphylococci,Haemophilus influenzae, Moraxella (Branhamella) catarrhalis andMycoplasma pneumoniae. The β-lactams are effective against all of these bacterial species, with the exception ofM. pneumoniae. We conducted a survey of β-lactam antibiotics currently on the Japanese market and compared them to other oral antibiotics used to treat respiratory infections. Ease of administration, based on the incidence of adverse effects, particularly diarrhea, the dosage form, taste, dosage per administration and the number of doses required per day, are reported.ZusammenfassungDie Compliance bei ambulanter Antibiotikatherapie im Kindesalter wurde überprüft. Dabei stellte sich heraus, daß in Japan etwa ein Viertel der Patienten nicht die volle Antibiotikadosis einnahmen. Gründe für ein eigenmächtiges Absetzen waren 1). die Eltern oder Betreuer sahen die Infektion als geheilt an. 2.) Das Kind verweigerte die Einnahme. 3.) Nebenwirkungen. Zu den häufigen Erregern von Atemwegsinfektionen im ambulanten Bereich gehören Pneumokokken, Streptokokken, Staphylokokken,Haemophilus influenzae, Moraxella (Branhamella) catarrhalis undMycoplasma pneumoniae. Die β-Laktamantibiotika sind gegen alle diese Bakterienspezies mit Ausnahme vonM. pneumoniae wirksam. Wir überprüften die derzeit auf dem japanischen Markt verfügbaren β-Laktamantibiotika und verglichen sie mit anderen oralen Antibiotika, die zur Behandlung von Atemwegs-infektionen eingesetzt werden. Berichtet wird über die Inzidenz von Nebenwirkungen, vor allem Durchfall, Zubereitungsart, Geschmack, Einzeldosis und erforderliche Anzahl von Tagesdosen.We carried out a survey in Japan to investigate compliance among children given oral antibiotics in an outpatient setting. The results of our survey revealed that, in Japan, approximately one-quarter of patients did not take their full course of antibiotics. Reasons for unsupervised self-discontinuation included: (1) the parent or guardian judged the infection to be cured; (2) the child refused to take the drug; and (3) the appearance of side effects. Causative organisms often involved in respiratory infections experienced in outpatient medicine include pneumococci, streptococci, staphylococci,Haemophilus influenzae, Moraxella (Branhamella) catarrhalis andMycoplasma pneumoniae. The β-lactams are effective against all of these bacterial species, with the exception ofM. pneumoniae. We conducted a survey of β-lactam antibiotics currently on the Japanese market and compared them to other oral antibiotics used to treat respiratory infections. Ease of administration, based on the incidence of adverse effects, particularly diarrhea, the dosage form, taste, dosage per administration and the number of doses required per day, are reported. Die Compliance bei ambulanter Antibiotikatherapie im Kindesalter wurde überprüft. Dabei stellte sich heraus, daß in Japan etwa ein Viertel der Patienten nicht die volle Antibiotikadosis einnahmen. Gründe für ein eigenmächtiges Absetzen waren 1). die Eltern oder Betreuer sahen die Infektion als geheilt an. 2.) Das Kind verweigerte die Einnahme. 3.) Nebenwirkungen. Zu den häufigen Erregern von Atemwegsinfektionen im ambulanten Bereich gehören Pneumokokken, Streptokokken, Staphylokokken,Haemophilus influenzae, Moraxella (Branhamella) catarrhalis undMycoplasma pneumoniae. Die β-Laktamantibiotika sind gegen alle diese Bakterienspezies mit Ausnahme vonM. pneumoniae wirksam. Wir überprüften die derzeit auf dem japanischen Markt verfügbaren β-Laktamantibiotika und verglichen sie mit anderen oralen Antibiotika, die zur Behandlung von Atemwegs-infektionen eingesetzt werden. Berichtet wird über die Inzidenz von Nebenwirkungen, vor allem Durchfall, Zubereitungsart, Geschmack, Einzeldosis und erforderliche Anzahl von Tagesdosen.

Adverse effects of antibiotics

The adverse effects caused by antibiotics and the interactions between other drugs based on the results of clinical studies on children recently conducted in Japan, as well as the results of previous studies in the literature were reviewed. Adverse effects of β‐lactam, macrolide and azalide antibiotics commonly observed in children included gastrointestinal symptoms such as diarrhea and loose stool, and hypersensitivity such as rash and fever. The incidences were 1–6% and 0.2–1.6%, respectively. Eosinophilia, thrombocytosis, and elevation of serum glutamate oxaloacetate transaminase and serum glutamate pyruvate transaminase were common abnormal laboratory findings. Although many of the antibiotics used in childen are relatively safe, cautions should be given because developing children tend to have adverse effects unique or common in children, in addition to those commonly seen in adults.

Septicemia in the Neonatal Intensive Care Unit Over the Past 15 Years

We retrospectively reviewed the records of 2093 infants hospitalized in the neonatal intensive care unit (NICU) of Ota General Hospital, Health Insurance Union of Fuji Heavy Industry, for 15 years from 1981 to 1995 to determine characteristics of septicemia. Fifty cases of clinically organisms were detected in blood cultures, were evaluated for patient-gestational age, birth weight, age (days) when septicemia occurred, causative organism, and administration of prophylactic antibiotics. When cases were classified by patient birth weight, the incidence of septicemia in the group weighing at least 1500 g was 1.0% (based on the total number of infants hospitalized in the same period), while those in the groups weighing 1000 g to 1499g and <1000 g were 10.1% and 22%, respectively, indicating that the incidence of septicemia increased markedly as the birth weight was reduced. When cases were grouped by patient age (days) when septicemia occurred, the incidence in the 7-day or older group was 76%, indicating predominantly horizontal transmission of infection in this group, rather than intrauterine infection or vertical transmission, whereas it fell to 24% in the group aged younger than 7 days at onset of septicemia. This tendency was more pronounced in those of lower birth weights. A variety of causative organisms were found, and their distribution was dependent on the administration of prophylactic antibiotics. When antibiotics were given prophylactically, detection of gram-negative rods increased markedly compared with that found in the group not given prophylactic antibiotics. Many causative organisms originated from the intestinal bacterial flora. Neonates who have to be hospitalized in NICU, like extremelylow birth-weight infants, have many factors such as endotracheal intubation, tube feeding, and administration of antibiotics, which inhibit the formation of normal intestinal bacterial flora, thus many of them possess extremely abnormal intestinal bacterial flora. This may contribute to the development of septicemia.