著者

宇野 芳史

出版者

日本耳鼻咽喉科感染症・エアロゾル学会

雑誌

日本耳鼻咽喉科感染症・エアロゾル学会会誌 (ISSN:21880077)

巻号頁・発行日

vol.8, no.3, pp.184-192, 2020-11-20 (Released:2020-11-20)

参考文献数

33

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急性咽頭炎,急性扁桃炎は日常診療において頻繁に遭遇する上気道疾患の一つである.「抗微生物薬適正使用の手引き」では,原因微生物としてウイルスが大半で,抗菌薬治療の適応となる細菌感染はA群β溶血性連鎖球菌のみが重要であり,A群β溶蓮菌迅速抗原検査または細菌培養検査でA群β溶蓮菌が検出されなかった症例に対しては抗菌薬投与による治療は不要としている.また投与する抗菌薬はAmoxicillinを中心としたペニシリン系抗菌薬が第一選択としている.しかし,実際の臨床の場においてはA群β溶蓮菌感染症であってもβラクタマーゼ産生菌との混合感染などによりペニシリン系抗菌薬での除菌失敗例,重症例でペニシリン系抗菌薬の投与で効果が期待できず,他の抗菌薬(ニューキノロン系抗菌薬,第3世代セフェム系抗菌薬等)の投与が必要と考えられる症例もある.他の耳鼻咽喉科感染症と同様,急性咽頭炎・急性扁桃炎においても重症度判定及びその重症度に従った抗菌薬の選択という考え方が重要である.また投与する抗菌薬はペニシリン系抗菌薬を第一選択としつつ,他の抗菌薬の選択も柔軟に考慮する必要がある.

著者

宇野 芳史

出版者

日本耳鼻咽喉科感染症・エアロゾル学会

雑誌

日本耳鼻咽喉科感染症・エアロゾル学会会誌 (ISSN:21880077)

巻号頁・発行日

vol.6, no.1, pp.1-7, 2018-01-20 (Released:2020-08-04)

参考文献数

23

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Antimicrobial therapy for acute infections of otorhinolaryngological conditions, especially ear and nose diseases, were described based on the “Clinical Practice Guidelines for the Diagnosis and Management of Acute Otitis Media (AOM) in Children in Japan, 2013 update” and the “Clinical Practice Guidelines for Acute Rhinosinusitis in Children and Adults in Japan, 2010 Additional Edition.” The method to treat these infections by selecting and administering antimicrobial agents in actual practice will also be explained at the same time. In actual treatment, it is important to first determine the pathogenic bacteria and then to select and administer appropriate antibiotics according to the results. The two major causal agents of these infectious diseases are Streptococcus pneumoniae and Haemophilus influenzae. If the infectious bacteria are unknown, then antimicrobial therapy against S. pneumoniae should be administered, as it is strongly pathogenic. Although judging the therapeutic effect is important, there is a need for using a scoring system to decide whether to continue antimicrobial therapy, change the antimicrobial agent, or stop antibiotic administration by judging the effectiveness of the therapy (improvement, healing). In the treatment of acute otitis media at our hospital, good treatment results have been obtained by applying such a policy for treatment.

著者

宇野 芳史

出版者

日本耳科学会

雑誌

Otology Japan (ISSN:09172025)

巻号頁・発行日

vol.16, no.5, pp.576-581, 2006-12-25 (Released:2011-06-17)

参考文献数

22

被引用文献数

1 3

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We investigated the efficacy of ear lavage with 3% hydrogen peroxide solution (oxydol) for refractory aural discharge related to acute otitis media after tympanotomy or insertion of a ventilation tube. The subjects were 30 patients (55 ears) in whom aural discharge persisted for 10 days or more despite therapy with antimicrobial agents. Ear lavage with 3% hydrogen peroxide solution (oxydol) was initiated, and antimicrobial agents was discontinued. Ear lavage was continued every day until aural discharge disappeared. In all patients, the disappearance of aural discharge was achieved within 14 days (mean: 6.9 days). In particular, the interval until its disappearance was 12 to 14 days (mean: 13.0 days) in patients with acute MRSA-related otitis media, but 7 days or less (mean: 6.0 days) in those in whom other types of bacteria were detected.Thus, ear lavage with 3% hydrogen peroxide solution (oxydol) was effective for refractory aural discharge related to acute otitis media after tympanotomy or insertion of a ventilation tube for the following reasons:1) 3% hydrogen peroxide solution (oxydol) destroyed the lipid membrane, DNA, and cellular contents of bacteria by generating hydroxy radicals.2) Oxygenation of the middle ear cavity via decomposition of 3% hydrogen peroxide solution (oxydol) normalized middle ear mucosa.3) Oxygenation of the middle ear cavity influenced the morphology of the pneumococcal membrane; it changed from the strongly pathogenic opaque type to the less pathogenic transparent type.