Vol.53 No.4 April 2005

Evaluation of efficacy and safety of piperacillin for pneumonia and secondary infection with chronic respiratory disease

Shigeru Itabashi¹⁾, Akira Watanabe²⁾, Mitsuo Kaku³⁾, Hiroaki Takeda⁴⁾, Katsunao Niitsuma⁵⁾, Kazuhiro Ozawa⁶⁾, Takashi Mouri⁷⁾, Kazutoshi Gomi⁸⁾, Yoshiyuki Nakai⁹⁾, Tatsuya Abe¹⁰⁾, Reiko Ono¹¹⁾, Noboru Asou¹²⁾, Hiroshi Iga¹³⁾, Mitsunobu Homma¹⁴⁾, Hideki Ikeda¹⁵⁾, Sumito Inoue¹⁶⁾, Hiroshi Saito¹⁷⁾, Tomei Tsukamoto¹⁸⁾, Shunji Kaise¹⁹⁾, Shinsaku Maeda²⁰⁾, Shuzo Suzuki²¹⁾, Yoshihiro Kazuta²²⁾ and Tatsuo Kawashima²³⁾

¹⁾Department of Respiratory Medicine, Shiogama City Hospital, 7-1 Kouzu-machi, Shiogama, Miyagi, Japan
²⁾Department of Respiratory Oncology and Molecular Medicine, Institute of Development, Aging and Cancer, Tohoku University
³⁾Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine
⁴⁾Department of Internal Medicine, Yamagata Saiseikai Hospital
⁵⁾Department of Internal Medicine, Fukushima Prefectural Aizu General Hospital
⁶⁾Department of Internal Medicine, National Hospital Organization, Hirosaki Hospital
⁷⁾Third Department of Internal Medicine, Iwate Medical University
⁸⁾Division of Respiratory Disease, Kitakami Saiseikai Hospital
⁹⁾Department of Respiratory Medicine, Sendai Kosei Hospital
¹⁰⁾Department of Respiratory Medicine, Tohoku Employees' Pension Welfare Hospital
¹¹⁾Department of Internal Medicine, Furukawa Seiryo Hospital
¹²⁾Division of Respiratory Disease, Miyagi Cardiovascular and Respiratory Center
¹³⁾Department of Internal Medicine, Akita Kumiai General Hospital
¹⁴⁾Department of Respiratory Medicine, Akita City Hospital
¹⁵⁾Internal Medicine, Pulmonary Division, Sanyudo Hospital
¹⁶⁾Department of Internal Medicine, Yamagata Prefectural Shinjo Hospital
¹⁷⁾Department of Internal Medicine, Yamagata Prefectural Nihonkai Hospital
¹⁸⁾Department of Internal Medicine, Yamagata Prefectural Central Hospital
¹⁹⁾Department of Internal Medicine, Ohara General Hospital
²⁰⁾Division of Respiratory Disease, Jusendo General Hospital
²¹⁾Second Department of Internal Medicine, Fukushima Medical University School of Medicine
²²⁾Department of Internal Medicine, Fukushima Red Cross Hospital
²³⁾Department of Internal Medicine, Toho University School of Medicine, Sakura Hospital

Abstract

Piperacillin (PIPC) has excellent antibacterial activities against Streptococcus pneumoniae, including penicillin-resistant Streptococcus pneumoniae (PRSP), and Haemophilus influenzae, including beta-lactamase-negative, ampicillin-resistant Haemophilus influenzae (BLNAR). To demonstrate this clinically, we evaluated the clinical efficacy of PIPC on pneumonia and secondary infection with chronic respiratory disease in which S. pneumoniae or H. influenzae was considered a prophlogistic bacteria.
We found that the clinical efficacy ratio was 98.4% in all patients, and disappearance of S. pneumoniae and H. influenzae was 92.9% and 95.8%, sufficiently fulfilling the intended purpose. Bacteriological efficacy was 96.9% in monomicrobial infection (S. pneumoniae: 100%, H. influenzae: 93.8%) and 84.2% in polymicrobial infection. Monomicrobial and polymicrobial infections became negative in 92.2%. When a patient was treated based on infection with S. pneumoniae or H. influenzae, even in mixed infection, sufficient clinical effect was obtained in those with or without mixed infection.
The minimum inhibitory concentration (MIC) of PIPC for S. pneumoniae and H. influenzae isolated in this study was as follows: for S. pneumoniae, the range of MIC was ≤0.06-4 μg/mL and MIC₉₀ was 4 μg/mL; and for H. influenzae, the range of MIC was ≤0.06-8 μg/mL and MIC₉₀ was 0.25 μg/mL. The antibacterial activity against penicillin-intermediate S. pneumoniae (PISP), PRSP, and BLNAR was 4 μg/mL of MIC₉₀ for PISP+PRSP and 0.25 μg/mL of MIC₉₀ for BLNAR.
PIPC is thus clinically effective against patients with pneumonia and (with) secondary infection in chronic respiratory disease by S. pneumoniae including PISP and PRSP, and H. influenzae including BLNAR. S. pneumoniae and H. influenzae are highly probable prophlogistic bacteria of community-acquired pneumonia and secondary infection in chronic respiratory disease. In view of this, PIPC should prove to be an appropriate antibacterial drug for empiric therapy for patients with community-acquired pneumonia and secondary infection in chronic respiratory disease.

Key word

piperacillin, Streptococcus pneumoniae, BLNAR, community-acquired pneumonia, post-marketing surveillance

Received

December 17, 2004

Accepted

February 21, 2005

Jpn. J. Chemother. 53 (4): 259-267, 2005