Treatment of acute enterocolitis with piromidic acid. I. Bacillary dysentery

Abstract

Piromidic acid (PA), a new chemotherapeutic agent produced in Japan, has so far been announced as particularly active against Gram-negative bacilli, readily absorbable upon oral use, and detectable at high concentration in urine and bile without any recognizable toxicity. In this series, the authors administered this agent to patients with infectious enterocolitis due to Gram-nega.ive bacilli, and in this first report, the authors reported the results of bacillary dysentery cases mainly from clinical and bacteriological viewpoints.Out of those who were admitted to Tokyo Municipal Bokuto Hospital during July-August, 1970, 82 cases (80 outbreak-cases and 2 sporadic cases) due to shigella sonnei were subjected and given PA of either 3.0g or 1.5g daily dose 3 times after meals per os for 5 days. The drug efficacy was mainly evaluated by eradication effect of the causatives from feces. Our laboratory tests using freshly isolated strains revealed MIC of PA to be 6.25-25.0mcg/ml.The results of clinical use were as follows:Dysenteric symptoms seen in one case were soothed within 5 days of PA medication initiated at the 2nd day of illness with 3.0g daily dose and, above all, stool appearance and frequency did not show reaggravation in the course thereafter.The eradication effects were compared between 3.0g and 1.5g PA administration, the number of cases being 63 and 19, respectively. Eradication rates within 5 days after finishing the medication were slightly better in the former group than in the latter, but if the days were extended to 2 weeks the rates became almost equal, i. e., redischarge rates being below 4% in both. This means the ranking of PA stands next to Kanamycin in the series of our experiments made with single antibiotic against resistant shigellosis to usual antibiotics.It is worth mentioning that, unlike most other chemotherapeutic agents, the eradication effects began to be more effectively seen in the course some time after finishing 5-day medication rather than immediately after that. Bacilli-positive rate was 19% and 30% in the 3.0g case and 1.5g case, respectively, at the last day of the medication, and likewise, 2.1% and 3.5% at the day after one week, 0.8% and 0% after two weeks. Only one case of all was needed rehospitalization for the treatment due to redischarge of shigella.To state conclusively, PA is considered to be worth trying against bacillary dysentery from the viewpoint based upon bacilli-ei adication effect, however, the effects upon clinical features are yet to be studied.