Vol.65 No.5 September 2017
A proposal for the future for the Japanese Society of Chemotherapy Part 3. Issues involved in infectious diseases due to antimicrobial-resistant microorganisms
Professor Emeritus, Teikyo University
Abstract
Currently in Japan, about 80% of the top three bacteria causing community-acquired respiratory tract infections (Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae) have either gene encoding or genetic mutations rendering them resistant to β-lactam and macrolide antibiotics. Infections caused by these bacteria are largely associated with infants' development of antibody responses in infants; unfortunately not only is the development of new oral antimicrobial agents with definite efficacy against these antimicrobial-resistant bacteria at a dead end, but concerned researchers and clinicians lack a sense of crisis.
The increasing number of penicillin-resistant S. pneumoniae (PRSP) and β-lactamase nonproducing ampicillin-resistant H. influenzae (BLNAR) in Japan is caused by the frequent use of oral cephem antibiotics. Oral cephem antibiotics selectively inhibit the functions of penicillin-binding protein (PBP), which mediates the synthesis of the septum at cell division. They damage the bacterial cell wall, but since it takes some time before bacteriolysis occurs, mutations in pbp2x or ftsI encoding enzymes of cell wall synthesis occur during this interval. In addition, many PRSPs have a macrolide-resistant gene. The reason is that transformation and transduction easily occur in S. pneumoniae.
The number of cases of bacterial meningitis associated with PRSP or BLNAR has greatly decreased through routine vaccination with the conjugate vaccine; however, PRSP started to emerge in S. pneumoniae of the non-vaccine serotype. BLNAR of nontypeable H. influenzae (NTHi) still continues to cause acute otitis media, and the incidence rate of recurrent otitis media has not changed.
The reason for epidemics of macrolide-resistant Mycoplasma pneumoniae (MRMP) is that bacteria continue to be transmissible and may spread in the community despite macrolide antibiotic therapy. Some physicians recommend tosufloxacin; however, MRMP continues to be transmissible even after the fever has subsided. We are left with the problem of how to suppress the transmission of the bacteria while shortening the duration of the use of tetracycline antibiotics, and how to minimize the side effects like abnormal tooth development associated with this therapeutic regimen.
The guideline on community-acquired respiratory tract infections must be updated on the indicated usage of antimicrobial agents for empiric therapy. In addition, academic societies that handle infectious diseases must present measures to also actively involve departments other than the clinical departments, such as pharmacy, chemistry, science, agriculture and veterinary medicine, as well to conduct research that will lead to the development of new anti-infectious medications. That is the responsibility that the Japanese Society of Chemotherapy should take in the community.
Key word
methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, β-lactamase negative resistant Haemophilus influenzae, macrolide-resistant Mycoplasma pneumoniae, vaccination
Received
December 16, 2016
Accepted
January 26, 2017
Jpn. J. Chemother. 65 (5): 688-735, 2017
