グラム陰性桿菌眼感染症におけるAztreonamの臨床評価

Clinical evaluation of aztreonam for ocular infections due to gram-negative Bacilli

　「新しいモノバクタム系抗生剤」Aztreonam （AZT）を細菌性眼感染症に臨床応用して，有用性と安全性を検討した．

　眼瞼蜂巣炎（2），急性涙嚢炎（4），慢性涙嚢炎（6），角膜浸潤（1），角膜潰瘍（4），化膿性虹彩毛様体炎（2），眼窩感染（1）の20症例に，AZTを1回1g1日1ないし2回，または1回2g1日1回点滴静注した．著効4例，有効13例，やや有効3例の結果で，有効率85.0％であった．

　疾患別有効率は眼瞼蜂巣炎，角膜浸潤，角膜潰瘍，眼窩感染では100％，慢性涙嚢炎83.3％，急性涙嚢炎75.0％，化膿性虹彩毛様体炎50.0％であった．

　分離菌別有効率ではK．pneumoniae, H．influenzae, S．marcescens, E．cloacaeには100％，P．aeruginosa 83.3％であった．

　初診時検出されたK．pneumoniae, S．marcescens, P．aeruginosa, P．mirabilisにすぐれた抗菌力を示し，Cefmetazole （CMZ），　Cefoperazone （CPZ），　Latamoxef （LMOX），　Ceftazidime（CAZ），およびCefsulodin （CFS）に比べてより高い感受性を示した．副作用は1例にもみられず，臨床検査値に異常を示したものはなかった．

We treated 20 cases with ocular infections using systemic aztreonam, a newly developed monobactam antibiotic agent. The cases included palpebral phle-gmon ( 2 cases), acute dacryocystitis ( 4 ), chronic dacryocystitis ( 6 ), corneal infiltration ( 1 ), cor-neal ulcer ( 4 ), purulent iridocyclitis ( 2) and orbital infection ( 1 ). Aztreonam was administered as intravenous drip at the daily dosis of 1 or 2 grams either once or twice daily.

The treatment was judged as excellent in 4 cases, good in 13 and fair in 3 cases, indicating an over-all rate of efficacy of 85%. It showed a 100% effi-cacy rate isolated pathogenic organisms including K. pneumoniae, H. infiuenzae, S. marcescens and E. cloa-cae. It was effective in 83% of cases infected by P. aeruginosa. Aztreonam showed excellent antimi-crobial activity to the initially isolated K. pneumoniae, S. marcescens, P. aeruginosa and P. mirabilis. These organisms showed higher susceptibility to atzreonam than CMZ, CPZ, LMOX, CAZ or CFS.

No clinical side effects nor abnormal laboratory date were observed throughout the clinical study. Aztreonam is considered to be a useful and safe injectable antibiotic agent in the treatment of ocular infections caused by gram-negative bacilli.