慢性下気道感染症におけるErythromycin長期治療に関する臨床的研究

Abstract

In order to establish useful therapeutic methods in chronic lower respiratory tract infection, the author carried out long-term chemotherapy using Erythromycin (EM) (600-1,200 mg/day) in cases with intractable and chronic lower respiratory infections for 12-41 months. Thirteen cases with DPB were the subjects of this study. All these patients complained of large amounts of purulent sputum and DOE, and had a decreasing of Pao₂. Major infected bacteria detected by TTA before therapy were H. influenzae, P. aeruginosa and S. pneumoniae, etc. With regard to the clinical effects, marked effect, moderate effect and slight effect were noted in 1, 10 and 2 cases, respectively, and 2 cases infected by P. aeruginosa were both effective. Improvement of QOL was noted in all cases. The disappearance of H. influenzae or P. aeruginosa was not noted by TTA after therapy. No significant side effects were noted during long-term chemotherapy. It was considered that early therapy is necessiated because the clinical effect is less in cases with elevated PaCO₂ before EM therapy. The acute exacervated bacteria which easily give rise to viral infections in infectious cases by P. aeruginosa or cases in which bacteria could not be significantly detected from the sputum were mainly H. influenzae or S. pneumoniae in 10 acute exacervated cases during EM therapy. Much attention must be paid to the interruption of the administration of EM because there are many cases where improvement of the transport mechanism of the mucous cilium and of inflammatory findings of the bronchial mucous membrane could not be detected even though clinical symptoms were improved. NK cell activity was elevated after EM administration, and EM inhibits production of elastase from P. aeruginosa. From these results, it is considered that this therapy is a newly useful therapeutic method in chronic lower respiratory tract infections because effectiveness can be obtained by the action of EM in both host and parasite.