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Antimicrobial therapy using sulfamethoxazole trimethoprim for Kawasaki disease patients unresponsive to intravenous immunoglobulin

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Open Journal of Pediatrics 2011年第3期1卷 27-29页

作者： Satoru Nagata Yuichiro Yamashiro Makoto Fujimori Yukihide Chiba yoshikazu ohtsuka Toshiaki Shimizu Departments of Pediatrics and Neonatology Shizuoka Hospital Juntendo University School of Medicine Division of Laboratory for Probiotics Research Juntendo University Postgraduate School Department of Pediatrics Juntendo University School of Medicine

Our previous study suggested that the production of superantigens and heat-shock protein 60 by small intestinal bacteria might play a role in Kawasaki disease (KD). We demonstrated that they were all resistant to commonly used antibiotics, except for sulamethoxazole trimethoprim (SMX-TMP). We used SMX-TMP for 7 cases of KD that were unresponsive to intravenous immunoglobulin (IVIG) and studied the antipyretic potency of this treatment. In 6 out of the 7 cases, we demonstrated that antipyretic potency was observed without side effects within 2 days of the initial administration. Antimicrobial therapy using SMX-TMP might represent a novel strategy for cases of KD that are unresponsive to IVIG.

关键词： Antimicrobial Therapy Intravenous Immunoglobulin Resistance Kawasaki Disease Sulfamethoxazole Trimethoprim

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Antibiotic Resistance of <i>Helicobacter pylori</i>and Eradication Rate in Japanese Pediatric Patients

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Advances in Microbiology 2017年第4期7卷 241-252页

作者： Tamaki Ikuse Yo Aoyagi Naho Obayashi Keisuke Jimbo Takahiro Kudo yoshikazu ohtsuka Thomas G. Blanchard Steven J. Czinn Toshiaki Shimizu Department of Pediatric and Adolescent Medicine Juntendo University Graduate School of Medicine Tokyo Japan Department of Pediatrics University of Maryland School of Medicine Baltimore USA

Helicobacter pylori (H. pylori) eradication rates achieved with a proton pump inhibitor (PPI), amoxicillin and clarithromycin have recently decreased to about 75% because of the increase in clarithromycin resistance in Japan. In the present study, H. pylori resistance rates against clarithromycin, amoxicillin and metronidazole were investigated in pediatric patients and eradication rates were evaluated when tailored antibiotics regimens based on antibiotic sensitivity data were used. We isolated H. pylori endoscopically from 77 pediatric patients suffering from abdominal symptoms. The susceptibility tests of H. pylori strains to clarithromycin, amoxicillin and metronidazole were examined and eradication therapy was tailored using the appropriate antibiotics. Seventy-seven patients were treated with a mean age of 12.16 ± 3.34 years (range, 4.92-19.75) consisting of 40 males and 37 females. The average resistance rates between 1998 and 2016 to clarithromycin, amoxicillin and metronidazole were 54.5% (42 of 77), 6.5% (5 of 77) and 5.2% (4 of 77) respectively. The prevalence of clarithromycin resistance increased significantly over time to reach 88.9% by 2013-2016. Successful eradication rates using tailored antibiotic treatment was 93.8% (61 of 65). Clarithromycin-based eradication therapy rate reached 92.6% against clarithromycin-sensitive strains. Metronidazole-based initial eradication therapy also had a high successful rate (97.0%) to clarithromycin-resistant strains. Although high rates of clarithromycin resistant H. pylori reaching about 90% were observed in Japanese children, tailored eradication therapy using the appropriate antibiotic agents were highly successful. H. pylori sensitivity testing and eradication therapy with appropriate antibacterial agents may contribute to accomplishment of high initial eradication rates and consequently reducing the incidence of developing gastric cancer.

关键词： Resistance Eradication Rate Susceptibility Test Clarithromycin Metronidazole

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A Retrospective Analysis of Three Non-Invasive Tests for Initial Diagnosis of <i>Helicobacter pylori</i>Infection in Children

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Advances in Microbiology 2017年第4期7卷 253-264页

作者： Tamaki Ikuse Takahiro Kudo Naho Obayashi Keisuke Jimbo Yo Aoyagi yoshikazu ohtsuka Thomas G. Blanchard Steven J. Czinn Toshiaki Shimizu Department of Pediatric and Adolescent Medicine Juntendo University Graduate School of Medicine Tokyo Japan Department of Pediatrics University of Maryland School of Medicine Baltimore USA

Proper diagnosis in the pediatric population is required to eradicate Helicobacter pylori (H. pylori) and prevent gastric cancer. Our aim was to assess the performance of non-invasive tests to diagnose H. pylori infection in pediatric patients. A retrospective analysis was performed on 141 pediatric patients requiring endoscopic evaluation and diagnostic tests for H. pylori infection to define the cause of abdominal symptoms. Non-invasive tests included the 13C-urea breath test (UBT), a monoclonal stool antigen test using enzyme-linked immuno-sorbent assay (mSAT), and a serum immunoglobulin G antibody test using antigens derived from Japanese individuals (S-Ab). This study investigated sensitivity, specificity, likelihood ratios for a positive and a negative test (LR+ and LR-), and accuracy of non-invasive tests, in comparison with invasive tests. Eighty two of 141 patients (58%) were recognized as H. pylori positive by invasive methods. When UBT, mSAT or S-Ab were analyzed, all were found to be effective over 94% accurate. Specificity ranged between 86.7% and 95.8%, and sensitivity ranged between 93.8% and 97.1%. When subjects were stratified into three distinct age groups, the best performance was achieved for 1-6 years old with mSAT at 100% for sensitivity, specificity, and accuracy. S-Ab yielded the best results for children 7-12 years old and the UBT test performed best for 13-18 years old. These results demonstrate the utility of UBT, mSAT, and S-Ab non-invasive tests in diagnosing H. pylori but suggest that certain tests may be optimal for children of distinct ages. Three non-invasive tests, UBT, mSAT and S-Ab showed sufficient sensitivity, specificity and accuracy for the initial diagnosis of H. pylori infection among pediatric patients. Non-invasive tests may contribute to achieving minimum invasive diagnosis with combining with a histological test and a culture test in children.

关键词： Accuracy Non-Invasive Tests Urea Breath Test Stool Antigen Test Serum Antibody Test

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Antimicrobial Therapy Using Sulfamethoxazole Trimethoprim for Kawasaki Disease Patients Unresponsive to Intravenous Immunoglobulin

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Open Journal of Pediatrics 2011年第3期

作者： Satoru Nagata Yuichiro Yamashiro Makoto Fujimori Yukihide Chiba yoshikazu ohtsuka Toshiaki Shimizu

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