Niro Okimoto

Kawasaki Hospital, Kōbe, Hyōgo, Japan

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Publications (184)168.15 Total impact


  • No preview · Article · Nov 2015 · European Journal of Internal Medicine
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    ABSTRACT: The clinical effect of Biapenem (BIPM) on Nursing and Healthcare-associated pneumonia (NHCAP) was evaluated. One hundred and three NHCAP patients (Group B: 52 patients, Group C: 51 patients) to whom BIPM was administered were included in this study. Clinical effect, bacteriological effect, and adverse events were examined. Results revealed efficacy in 45 of 52 patients (efficacy rate: 86.5%) of NHCAP Group B, and 43 of 51 patients (efficacy rate: 84.3%) of NHCAP Group C, 88 of 103 patients (efficacy rate: 85.4%) as a whole. As for bacteriological effect, 10 (76.9%) of 13 Pseudomonas aeruginosa strains, 9 (90.0%) of 10 Klebsiella pneumoniae strains, 7 (87.5%) of 8 methicillin-sensitive Staphlococcus aureus strains, and 7 (100%) of 7 Streptococcus pneumonia strains were eradicated. As a whole, 38 (80.9%) of 47 strains were eradicated. Adverse events included drug fever and drug eruption in one patient each, and abnormal laboratory findings, including mild hepatic dysfunction in 18 patients and mild renal dysfunction in 5 patients. Based on the above, it was concluded that BIPM shows excellent clinical effect on NHCAP with fewer adverse events. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
    No preview · Article · May 2015 · Journal of Infection and Chemotherapy
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    ABSTRACT: The ELNAS Plate Chlamydophila pneumoniae commercial test kit for the detection of anti-C. pneumoniae-specific immunoglobulin M (IgM), IgA and IgG antibodies has become available in Japan recently. To determine the optimum serum collection point for the ELNAS plate in the diagnosis of C. pneumoniae pneumonia, we analyzed the kinetics of the antibody response in patients with laboratory-confirmed C. pneumoniae pneumonia. We enrolled five C. pneumoniae pneumonia cases and collected sera from patients for several months. The kinetics of the IgM and IgG antibody responses were similar among the five patients. Significant increases in IgM and IgG antibody titer between paired sera were observed in all patients. IgM antibodies appeared approximately 2-3 weeks after the onset of illness, reached a peak after 4-5 weeks, and were generally undetectable after 3-5 months. IgG antibodies developed slowly for the first 30 days and reached a plateau approximately 3-4 months after the onset of illness. The kinetics of IgA antibody responses were different among the five patients, and significant increases in IgA antibody titer between paired sera were observed in only two patients. Although the sample size was small, the best serum collection time seemed to be approximately 3-6 weeks after onset of illness when using a single serum sample for the detection of IgM antibodies. Paired sera samples should be obtained at least 4 weeks apart. IgA antibody analysis using ELNAS may not be a useful marker for acute C. pneumoniae pneumonia. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Mar 2015 · Journal of Infection and Chemotherapy
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    ABSTRACT: To clarify the detection failure rate of chest radiography for the identification of nursing and healthcare-associated pneumonia (NHCAP), we compared high-resolution computed tomography (HRCT) with chest radiography simultaneously for patients with clinical symptoms and signs leading to a suspicion of NHCAP. We analyzed 208 NHCAP cases and compared them based on four groups defined using NHCAP criteria, patients who were: Group A) resident in an extended care facility or nursing home; Group B) discharged from a hospital within the preceding 90 days; Group C) receiving nursing care and had poor performance status; and Group D) receiving regular endovascular treatment. Chest radiography was inferior to HRCT for the identification of pneumonia (149 vs 208 cases, p < 0.0001). Among the designated NHCAP criteria, chest radiography identified pneumonia cases at a significantly lower frequency than HRCT in Group A (70 vs 97 cases, p = 0.0190) and Group C (86 vs 136 cases, p < 0.0001). The detection failure rate of chest radiography differed among NHCAP criteria; 27.8% in Group A, 26.5% in Group B, 36.7% in Group C and 5.8% in Group D. Cerebrovascular disease and poor functional status were significantly more frequent in patients in Groups A and C compared with those in Groups B and D. Physicians may underestimate pneumonia shadow in chest radiographs in patients with NHCAP, and the detection failure rate of chest radiography differed among NHCAP criteria. Poor functional status may correlate with the low accuracy of chest radiography in diagnosing pneumonia. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Mar 2015 · Journal of Infection and Chemotherapy
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    ABSTRACT: A rapid antigen kit for the detection of the Mycoplasma pneumoniae ribosomal protein L7/L12 using an immunochromatographic assay, Ribotest Mycoplasma, became available in Japan in 2013. To determine the sensitivity of Ribotest compared with real-time polymerase chain reaction (PCR), we prospectively performed these two tests simultaneously in adolescent and adult patients with community-acquired pneumonia (CAP). In addition, we retrospectively analyzed the theoretical sensitivity of Ribotest using M. pneumoniae PCR-positive specimens from previous studies. In prospective study, 118 CAP cases were enrolled, and 16 cases were diagnosed as M. pneumoniae pneumonia; eight cases were PCR-positive, one case was culture positive, and all cases demonstrated a four-fold increase in antibody titer. Ribotest was positive in 15 cases; five cases were PCR positive and 10 cases were PCR negative. For the PCR was control test, the sensitivity, specificity, and overall agreement with Ribotest were 62.5%, 90.9%, and 88.9%, respectively. In the retrospective study, we used 1110 M. pneumoniae PCR-positive specimens, which are collected from pediatric patients with respiratory tract infection who visited 65 institutions throughout Japan. Using a cut-off level for the Ribotest of 8.3 × 10(4) copy/mL in transport medium, 667 (60.0%) specimens were theoretically positive. In conclusion, our prospective and retrospective results demonstrated that the diagnostic sensitivity of Ribotest compared with PCR was not high, at approximately 60%. Thus, treatment decisions about M. pneumoniae pneumonia should be based on clinical findings such as Japanese Respiratory Society scoring system and not on Ribotest results alone. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
    No preview · Article · Feb 2015 · Journal of Infection and Chemotherapy
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    ABSTRACT: A 29-year old man consulted his primary care physician because of cough and fever, and was referred to our hospital for further investigation of an abnormal chest shadow. He was suspected of having aspergillosis in his right S10 segment. Anti-microbial agents were not effective, and right lower lobectomy was performed. Fungi of Aspergillus were found in the bronchus in pulmonary segment S9 of the right lower lobe, and the patient was pathologically diagnosed with chronic necrotizing aspergillosis. We present a resected case of chronic necrotizing aspergillosis with a clinical course of repeated spontaneous recovery and relapse, with a review of the literature.
    Full-text · Article · Jan 2015 · The Journal of the Japanese Associtation for Chest Surgery
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    ABSTRACT: Serum interleukin (IL)-18 level was thought to be a useful as a predictor of refractory or severe Mycoplasma pneumoniae pneumonia, and steroid administration is reported to be effective in this situation. The serum levels of IL-18 correlated significantly with those of lactate dehydrogenase (LDH). The purpose of this study was to set a standard for the initiation of steroid therapy in M. pneumoniae pneumonia using a simple serum marker. We analyzed 41 adolescent and adult patients with refractory or severe M. pneumoniae pneumonia who received steroid therapy, and compared them with 108 patients with M. pneumoniae pneumonia who responded to treatment promptly (control group). Serum LDH levels were significantly higher in the refractory and severe group than in the control group at the initiation of steroid therapy (723 vs 210 IU/L, respectively; p < 0.0001). From receiver operating characteristic curve analysis, we calculated serum LDH cut-off levels of 364 IU/L at initiation of steroid therapy and 302 IU/L at 1–3 days before the initiation of steroid therapy. The administration of steroids to patients in the refractory and severe group resulted in the rapid improvement of symptoms and a decrease in serum LDH levels in all patients. Serum LDH level can be used as a useful parameter to determine the initiation of steroid therapy in refractory or severe M. pneumoniae pneumonia. A serum LDH level of 302–364 IU/L seems to be an appropriate criterion for the initiation of steroid therapy.
    No preview · Article · Dec 2014 · Journal of Infection and Chemotherapy
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    ABSTRACT: We analysed 53 cases of laboratory-confirmed Mycoplasma pneumoniae infection with cough lasting ≥7 days and chest radiography showing no abnormal findings. Twenty-two (41%) of those patients showed abnormal findings on chest high-resolution computed tomography. In the daily clinical setting, for assessment of acute cough, physicians should be aware that it is difficult to confirm bronchiolitis or bronchopneumonia due to M. pneumoniae by chest radiography.
    Preview · Article · Dec 2013 · Respirology
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    ABSTRACT: We investigated differences in the clinical findings between 30 patients with macrolide-resistant Mycoplasma pneumoniae pneumonia and 43 patients with macrolide-sensitive M. pneumoniae pneumonia in adolescents and adults. No differences in clinical presentation were observed between the two groups. Among patients with macrolide-resistant Mycoplasma pneumoniae pneumonia, treatment was more effective in the groups that received quinolones and minocycline than in the group that received macrolides (P = 0.0361 and P = 0.0237, respectively).
    Preview · Article · Jul 2013 · Antimicrobial Agents and Chemotherapy
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    ABSTRACT: Outbreaks of Mycoplasma pneumoniae have occurred in closed surroundings, including among families, university students, in military camps, and in schools, but available data on outbreaks of macrolide-resistant (MR) M. pneumoniae are limited. We encountered a family outbreak of MR M. pneumoniae pneumonia in four sisters (16, 14, 10, and 8 years of age). M. pneumoniae was isolated from all four patients, and an A-to-G transition at position 2063 in domain V of the 23S rRNA gene was identified. Although three of four patients received azithromycin, which is the first-choice antimycoplasmal agent, this agent was not effective. All isolates had an identical antibiotic susceptibility pattern. The MIC values for 14- and 15-membered macrolides, such as erythromycin, clarithromycin, and azithromycin, were >128, >128, and 64 μg/ml, respectively. On admission, all four patients were diagnosed with suspected M. pneumoniae pneumonia using the Japanese Respiratory Society (JRS) guidelines scoring system. We carried out culture and polymerase chain reaction tests for the detection of M. pneumoniae in their parents (mother, 49 years old, and father, 56 years old) four times, but no M. pneumoniae organism was detected using either test. In conclusion, MR M. pneumoniae strains can occur in outbreaks in closed surroundings, such as within families, as well as macrolide-sensitive strains. To prevent outbreaks of M. pneumoniae infection, especially MR M. pneumoniae, in closed populations, physicians should pay careful attention to the potential occurrence of infections involving MR M. pneumoniae.
    No preview · Article · Apr 2013 · Journal of Infection and Chemotherapy
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    ABSTRACT: Background Several symptoms are classically thought to be suggestive of pertussis in children, but the diagnostic value of these symptoms in adolescent and adult patients is unclear. We evaluated the accuracy of the clinical findings for the early presumptive diagnosis of pertussis in adolescent and adult patients. Furthermore, we measured fractional exhaled nitric oxide (FeNO) with regard to whether we could distinguish eosinophilic inflammation of the airway and pertussis. FeNO is not expected to be associated with pertussis. Methods We compared 183 cases with laboratory-confirmed pertussis using serology and polymerase chain reaction and 1,132 cases without laboratory-confirmed pertussis. Results Among pertussis patients, paroxysmal cough was common with 90% sensitivity, but the specificity was low (25%). Posttussive vomiting and whoop were less common (sensitivity 25% and 19%, respectively), but both showed greater specificity for pertussis (80% and 86%, respectively). Posttussive gagging was observed with intermediate frequency and provided greater specificity (49% and 77%, respectively). Pertussis cases were most frequent between May and August with a peak in June. The mean FeNO value for the pertussis patients was 18.2 ± 9.2 ppb, which was significantly lower than that in asthma patients (56.9 ± 20.3 ppb, p <0.001). The most useful definition was posttussive vomiting and/or gagging, and a plus normal FeNO value, which had a sensitivity of 72% and a specificity of 70%. Conclusions Clinical symptoms and laboratory data are of limited value in making the diagnosis of pertussis, and it was clinically difficult to differentiate adolescent and adult patients with or without pertussis. However, pertussis should be considered if patients have posttussive vomiting and/or gagging and a normal FeNO concentration.
    Full-text · Article · Mar 2013 · BMC Infectious Diseases
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    ABSTRACT: A 27-year-old, previously healthy woman was admitted to our hospital for mild pneumonia. After 2 days ceftriaxone sodium administration, her chest radiograph revealed a rightward mediastinal shift caused by atelectasis of the upper portion of the right lung. Bronchoscopic examination showed swelling in the right upper lobe bronchus and obstruction in the B1 segmental bronchus caused by complete edematous swelling. Histopathology showed acute cellular bronchitis with edema of the bronchial wall containing lymphocytes, plasma cells, and macrophages. Mycoplasma pneumoniae was detected by culture and a polymerase chain reaction test using sputum collected during bronchoscopy, and treatment was changed to minocycline. After 7 days antibiotic therapy, her condition improved and no relapse was observed. Identification of point mutations in domain V of the 23S rRNA for macrolide-resistant M. pneumoniae was performed, and an A-to-G transition at position 2063 in domain V of the 23S rRNA gene was identified. Atelectasis caused by M. pneumoniae is thought to be a common associated finding in pediatric patients, but it is rare in adults. In addition, our patient showed extremely unusual findings with obstruction caused by complete edematous swelling.
    No preview · Article · Mar 2013 · Journal of Infection and Chemotherapy
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    ABSTRACT: Nursing and healthcare-associated pneumonia (NHCAP) is a new category that is distinct from community-acquired pneumonia that has been documented in the 2011 Japanese Respiratory Society (JRS) guidelines. We aimed to evaluate an ELNAS Plate test for detecting anti-Chlamydophila pneumoniae-specific immunoglobulin M (IgM) antibodies in patients with NHCAP, by comparing the results of the ELNAS test with those of the Hitazyme enzyme-linked immunosorbent assay (Hitazyme-ELISA) and those of immunoblotting and microimmunofluorescence (MIF) tests. During the study period, we enrolled 739 patients with pneumonia in a university hospital and 812 patients with pneumonia in a community hospital; of these, 250 (34 %) and 349 (43 %), respectively, were classified as having NHCAP. C. pneumoniae pneumonia was detected in five cases by the MIF test and ELNAS test. All five cases demonstrated significant IgG antibody seroconversion, while one case was IgM-positive. Sixty-seven of the total of 599 patients (11 %) were C. pneumoniae IgM-positive on the Hitazyme-ELISA. One of the IgM-positive cases was confirmed by other methods and was shown to be a true positive. In the remaining cases, however, three other tests-the ELNAS test, the MIF test, and immunoblotting analysis-did not reveal any positive cases. The ELNAS, Hitazyme-ELISA, and MIF tests did not detect any significant increases in IgG or IgA antibody titers between paired sera. The results of the newly available ELNAS test for detecting anti-C. pneumoniae-specific IgM antibody correlated well with the results of the other established serological tests. To increase the diagnostic rate in patients with NHCAP, physicians should measure IgG antibody rather than IgM antibody using paired sera.
    No preview · Article · Oct 2012 · Journal of Infection and Chemotherapy
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    ABSTRACT: Atypical pathogens Mycoplasma pneumoniae and Chlamydophila pneumoniae play an important role in community-acquired pneumonia. However, it has been pointed out that positive enzyme-linked immunosorbent assay (ELISA, Hitazyme C. pneumoniae) IgM reactivity is frequent among M. pneumoniae pneumonia patients. To clarify the reactivity of ELISA IgM in M. pneumoniae pneumonia, findings were compared with immunoblotting, ELNAS Plate C. pneumoniae (ELNAS) and the micro-immunofluorescence (MIF) test. Ninety-eight serologically confirmed cases with M. pneumoniae pneumonia and 10 cases with C. pneumoniae pneumonia were enrolled in this study. C. pneumoniae IgM-positive cases measured by the ELISA were observed in 30 (30 %) patients with M. pneumoniae pneumonia. However, there were no positive cases by immunoblotting, ELNAS, or MIF test. These cases determined to be IgM positive only in the ELISA were all negative by another serological test, recombinant enzyme immunoassay (rEIA), and these positive results in the ELISA were considered to be false-positive reactions. In contrast, IgM-positive findings in patients with C. pneumoniae pneumonia did not show any positive reaction in M. pneumoniae antibody titer. ELISA showed a high frequency of false-positive findings in patients with M. pneumoniae pneumonia, which included false-positive cases with a high titer for IgM. To accurately diagnose C. pneumoniae infection in various studies, including respiratory infections, researchers should consider the IgM false-positive reaction with ELISA in patients with suspected atypical pneumonia.
    No preview · Article · Oct 2012 · Journal of Infection and Chemotherapy
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    ABSTRACT: Background Although the prevalence of macrolide-resistant Mycoplasma pneumoniae isolates in Japanese pediatric patients has increased rapidly, there have been no reports concerning macrolide-resistant M. pneumoniae infection in adolescents aged 16 to 19 years old. The purpose of this study was to clarify the prevalence and clinical characteristics of macrolide-resistant M. pneumoniae in adolescent patients with community-acquired pneumonia. Methods A total of 99 cases with M. pneumoniae pneumonia confirmed by polymerase chain reaction (PCR) and culture were analyzed. Forty-five cases were pediatric patients less than 16 years old, 26 cases were 16 to 19-year-old adolescent patients and 28 cases were adult patients. Primers for domain V of 23S rRNA were used and DNA sequences of the PCR products were compared with the sequence of an M. pneumoniae reference strain. Results Thirty of 45 pediatric patients (66%), 12 of 26 adolescent patients (46%) and seven of 28 adult patients (25%) with M. pneumoniae pneumonia were found to be infected with macrolide-resistant M. pneumoniae (MR patients). Although the prevalence of resistant strains was similar in pediatric patients between 2008 and 2011, an increase in the prevalence of resistant strains was observed in adolescent patients. Among 30 pediatric MR patients, 26 had an A-to-G transition at position 2063 (A2063G) and four had an A-to-G transition at position 2064 (A2064G). In 12 adolescent MR patients, 10 showed an A2063G transition and two showed an A2064G transition, and in seven adult MR patients, six showed an A2063G transition and one showed an A2064G transition. Conclusions The prevalence of macrolide-resistant M. pneumoniae is high among adolescent patients as well as pediatric patients less than 16-years old. To prevent outbreaks of M. pneumoniae infection, especially macrolide-resistant M. pneumoniae, in closed populations including among families, in schools and in university students, physicians should pay close attention to macrolide-resistant M. pneumoniae.
    Full-text · Article · May 2012 · BMC Infectious Diseases
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    ABSTRACT: Background and objective: The Japanese Respiratory Society (JRS) scoring system is a useful tool for the early and simple presumptive diagnosis of atypical pneumonia (Mycoplasma pneumoniae and Chlamydia pneumoniae pneumonia). However, it has been suggested that it is difficult to diagnose atypical pneumonia in the elderly using this system. In the present study, we evaluated the accuracy and usefulness of the JRS scoring system for diagnosing atypical pneumonia in different age groups. Methods: Cases of M. pneumoniae (n = 262), C. pneumoniae (n = 98) and common bacterial pneumonia (n = 364) were analysed. Results: For both atypical pneumonias, the frequency of comorbid illnesses and being in a higher risk category were significantly greater in elderly (age ≥60 years) than in non-elderly patients (age <60 years). One or more additional aetiological factors were more frequently present in elderly than in non-elderly patients. The diagnostic sensitivity and specificity for atypical pneumonia were 39% and 88%, respectively, in the elderly group, and 86% and 88%, respectively, in the non-elderly group. When the patients were stratified into 10-year age groups, the diagnostic sensitivity was highest in the 18- to 29-year age group and decreased from the youngest to the oldest age group. Conclusions: These results indicate that it is difficult to distinguish between atypical pneumonia and bacterial pneumonia in the elderly using the JRS scoring system. When treating patients aged ≥60 years, physicians should use fluoroquinolones or β-lactam antibiotics + macrolides as empirical first-choice drugs so as to always provide antibiotic protection against potential atypical pathogens.
    Preview · Article · May 2012 · Respirology
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    ABSTRACT: We studied the positive response rate with QuantiFERON-TB GOLD In-Tube in patients with Mycobacterium avium complex disease. We evaluated 62 subjects with M. avium complex disease. QuantiFERON-TB GOLD In-Tube was performed for all the subjects. The positive response rate with QuantiFERON-TB GOLD In-Tube and the history of pulmonary tuberculosis in patients who showed a positive response were evaluated. Seven patients (11.3%) showed a positive response with QuantiFERON-TB GOLD In-Tube. These patients were elderly (age, 72-87 years) and had a history of pulmonary tuberculosis. Eleven other patients with a history of pulmonary tuberculosis showed a negative response with QuantiFERON-TB GOLD In-Tube. Half or less than half of the elderly patients with M. avium complex disease and a history of pulmonary tuberculosis showed a positive response with QuantiFERON-TB GOLD In-Tube.
    No preview · Article · Apr 2012 · Kekkaku: [Tuberculosis]
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    Full-text · Article · Feb 2012 · Respiratory care
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    ABSTRACT: The Japan Respiratory Society documented a new category of guidelines for nursing and healthcare-associated pneumonia (NHCAP), which is distinct from community acquired pneumonia (CAP). The objective of this study was to determine the epidemiological differences between NHCAP patients in a teaching university hospital and a community hospital. In addition, to clarify the strategy for treatment of NHCAP, we investigated the role of atypical pathogens. We analyzed 250 NHCAP and 421 CAP cases in a university hospital and 349 NHCAP and 374 CAP cases in a community hospital. Patient age and the incidences of poor general condition were significantly higher in the community hospital compared with those in the university hospital. The distribution and frequency of pathogens, especially multidrug-resistant (MDR) pathogens, were significantly different between the two hospitals. Central nervous system disorders, dementia and poor performance status, which was possibility related to aspiration pneumonia, were significantly more frequent in patients with NHCAP compared with those with CAP in both hospitals. Atypical pathogens were detected in a few cases in patients with NHCAP. There were many differences in the clinical characteristics between NHCAP patients in a university hospital and a community hospital even for hospitals located in the same area. Aspiration pneumonia was thought to be the main characteristic of NHCAP in both hospitals. Thus, all NHCAP patients did not need the same empiric therapy with a multidrug regimen directed against MDR pathogens. In addition, physicians rarely need to consider atypical pathogens in NHCAP treatment.
    No preview · Article · Jan 2012 · Internal Medicine
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    ABSTRACT: Moxifloxacin is a respiratory quinolone that is expected to be useful for treating community-acquired bacterial pneumonia, but few clinical studies and not a detailed evaluation of its pharmacokinetics have been conducted in Japan in patients with pneumonia. We assessed the efficacy and safety of moxifloxacin in 18 patients with community-acquired bacterial pneumonia using pharmacokinetic-pharmacodynamic analysis. There was significant improvement in body temperature, white blood cell count, C-reactive protein, and chest X-ray score on day 3 of moxifloxacin treatment, which persisted until the completion of treatment (all p < 0.05). Nine strains, including Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, and Enterobacter cloacae, were isolated from sputum cultures of nine patients. The isolated strains were eradicated by moxifloxacin. The mean area under the concentration-time curve from 0 to 24 hours [AUC(0-24 h) (AUC(0-24 h,ss))], maximum plasma concentration (C(max)), and trough plasma level (C(trough)) of moxifloxacin at steady state was 52.0 μg h/ml, 4.5, and 0.9 μg/ml, respectively. Mean AUC(0-24 h,ss)/mimimum inhibitory concentration (MIC), and C(max)/MIC ratios for patients in whom MICs of moxifloxacin were determined for pathogenic bacteria were 723 and 62, respectively. The median AUC(0-24 h,ss)/MIC and C(max)/MIC ratios (based on Monte Carlo simulation employing MICs for 257 strains of S. pneumoniae collected during a respiratory infection survey by the Japanese Society of Chemotherapy in 2007) were 209.56 and 17.88, respectively. Thus, when the target for the AUC/MIC ratio was set at ≥30 and that for the C(max)/MIC ratio at ≥5, the achievement rate for these two parameters was 97.36% and 96.71%, respectively. Two patients (11%) experienced three adverse effects [one nausea, another increased aspartate aminotransferase (AST) and alanine aminotransferase (ALT)], but the events were not serious. Based on these results, moxifloxacin (400 mg once daily) was considered useful for treating community-acquired bacterial pneumonia and is expected to show excellent efficacy and safety as well as suppressing the emergence of resistance.
    No preview · Article · Aug 2011 · Journal of Infection and Chemotherapy

Publication Stats

752 Citations
168.15 Total Impact Points

Institutions

  • 2001-2015
    • Kawasaki Hospital
      Kōbe, Hyōgo, Japan
  • 1990-2015
    • Kawasaki Medical University
      • Department of Acute Medicine
      Kurasiki, Okayama, Japan
  • 1990-2012
    • Kawasaki Saiwai Hospital
      Kawasaki, Fukuoka, Japan
  • 1999
    • The Jikei University School of Medicine
      • Department of Internal Medicine
      Edo, Tōkyō, Japan