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緒言
慢性中耳炎に対する鼓室内注入療法は,既に各抗生物質に就て数多くの報告がなされている。慢性中耳炎の局所化学療法には多くの疑問があり,慢性中耳炎の大部分のものは,恐らくこれだけでは完全治癒は望みえられないと思われる。それは中耳炎の治癒に関しては生体側の諸条件特に病理学的諸条件が大きく関与してくるので,細菌だけを対象とする化学療法で完全治癒を望むのは困難である場合が少なくないからである。併し急性増悪症状を呈しているものには相当有効であり,慢性型のものでも患者が最も不快とする耳漏を停止せしめ,種々の自覚症状を軽快せしめるには,大いに役立てうるもので其の点臨床上相当利用しうる治療法である。
今迄使用された薬剤としては,サルフア剤,ペニシリン,ストレプトマイシン,オーレオマイシン,テラマイシン,クロラムフエニコール,コリスチン,等々あるが我々は今回最近屡々問題とされるペニシリン耐性葡萄球菌に対してエリスロマイシン(アイロタイシン),交代菌として屡々問題とされる緑膿菌に対してポリミキシンBを使用し,細菌学的検討と,臨床的の観察を試みたので報告する。
Clinical observations are made with topical use of ilotycin otic as ear drops for treatment of otitis media in which staphylococci were demonstrated in pure culture. Favoroble responses are obtained in 70 percent of cases However, it is shown that, when hat, when all types of otitis media are taken as a whole, only 27 percent are found to be affected by microorganism in which ilotycin appear to be effective. Therefore, if ilotycin is to be use at random for all types of otitis mediathe effectivity of such treatments may be reduced to mere 20 percent of the cases treated. Tests in vitro using ilotycin against staphylococcus show effectivity by 92 percent, a fact which earns for itself an important place in the means of clinical armamentarium.
For treatment of otitis media that include after-treatment of mastoidectomy in which Pseudomonas aeruginosa was obtainable in pure culture, the use of polymixin B appeared to be effective in 70 percent of cases.
It is shown that, when repeated cultures are taken during the course of chemotherapy in otitis media, even when the aural discharge may fail to stop completely, the cultures will eventually become bacteria-free. With use of ilotycin 2 cases of secondary bacterial invasion were encountered ; none by use of polymixin B. In conclusion, the authors state that, in order to institute chemotherapy adequately tests should be run determining bacterial sensitivity to antibiotic to be used by taking cultures in each case.
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