Oral kanendomycin therapy in antibiotic-resistant bacillary dysentery and other acute febrile diarrheal diseases

Abstract

Kanendomycin (KDM), a new antibiotic derived from Streptomyces kanamyceticus, was administrated orally to 70 patients who were sent to the Department of Legal Communicable diseases, Tokyo Municipal Bokuto Hospital under the diagnosis of Bacillary dysentery (BD) during the period from April to August, 1969. By the laboratory data they were later revealed as BD (18 cases), salmonellosis (S) (8), pathogenic coli (PC) infection (19), and acute febrile diarreal cases of unknown cause (AFD) (25). In all, 80 mg/kg/day of KDM, every 6 hours, 4 times a day, was given for successive 7 days from admission.In sensitivity test, all strains were suppressed by 2mcg/ml KDM concentration except one strain of shigella by 10mcg/ml, and two strains of PC, one by 30mcg/ml and the other over 50mcg/ml.Clinical observations: 1) Effects to fever: On an average, the body temperature was normalized within two days of medication in all diseases group. 2) to stool frequency: The frequency was normalized (two times a day or less) within 3 days in BD, 7 days in S, 6 days in PC infection, and 6 days in AFD. 3) to stool appearances: Blood and pus disappeared within 4 days in BD, 6 days in S, 4 days in PC infection, and 3 days in AFD. Mucus was still seen by the end of the first week in 60% in BD, 87% in S and complete recovery from mucus discharge needed almost 3 weeks in the both. The recovery was a little earlier in PC infection, and almost the same as BD or S in the case of AFD. 4) to eradication of the causatives: Bacillary discharge was halted within 3 days in BD, 4 days in S. Redischarge was seen in 13% of S at some time between the second week and the third week. The positive rate was decreased to 7-13% in the course of medication in PC infection, but rose again to 27% after the halt of medication.Conclusively, the author feel justified in evaluating the antibiotic, KDM, as recommendable in the treatment of bacillary dysentery due to resistant strains to usual antibiotics, in view of its excellent eradicating effect to causative agents. An impression is that the longer medication would be advisable in the case of salmonellosis. There are still problems to be solved in the case of pathogenic coli infection.