アミノ配糖体の大量点滴静注法を中心とした３剤併用投与の有用性　急性白血病併発感染症の治療への応用

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タイトル別名
  • TREATMENT OF INFECTION IN ACUTE LEUKEMIA WITH A LARGE DOSE OF AMINOGLYCOSIDE
  • アミノ ハイトウタイ ノ タイリョウ テンテキ ジョウチュウホウ オ チュウシ
  • 急性白血病併発感染症の治療への応用

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Thirty one episodes of infection in 28 patients with acute leukemia were treated with a large dose of aminoglycoside (Tobramycin; TOB, Amikacin; AMK) in combination with penicillin (PC) and cephalosporin (CEPs)(regimen A: TOB+PC+CEPs, regimen B: AMK+PC+CEPs). TOB (120-180mg × 3/day) and AMK (300-400mg/day) were administered for about one hour by i. v. drip infusion at every 8 hours.<BR>Mean dose of TOB and AMK was 7.0mg/kg/day and 19.8mg/kg/day, respectively and duration ranged from 4 to 19 days for TOB and from 3 to 27 days for AMK, respectively. Twenty five causative organisms, which were obtained from 16 episodes of infection, were mainly composed with Pseudomonas aeruginosa, Klebsiella, Serratia sp. and Enterobacter. The clinical effectiveness was recognized at 68.8% in regimen A and 73.3% in regimen B, respectively. The total response rate of regimen A+B was 71.1%. Only one patient, who was treated with AMK+CEPs for 14 days, showed a transient renal impairment, however, it was improved 10 days after the cessation of chemotherapy.<BR>Studies on serum concentration of TOB and AMK, which were done in normal volunteer, showed that the highest concentration of both agents were never beyond the toxic level, when they were administered in one hour by i. v drip infusion.<BR>In conclusion, the administration of a large dose of aminoglycoside by i. v drip infusion should be recommended for the treatment of serious infection in acute leukemia.

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