Clinical Study on Slight Fever

Between May 1981 and April 1986, 1402 patients were admitted to the Department of Primary Care Medicine of Kawasaki Medical School Hospital. Of these, 452 patients had a slight fever ranging from 37.0°C to 37.9°C. We analyzed those patients clinically. Infection ranked first as the cause of slight fever, followed by malignancy, collagen disease and others. About 50% of the cases were of unknown origin, and many cases with CRP and ESR almost within the normal range convalesced satisfactorily. The measurement of CRP and ESR in slight fever patients were useful to exclude organic slight fever. The cases with a slight fever of unknown origin appearing for a long term also often had nonorganic diseases such as depression or neurosis. Almost all of these cases were placed in the category of habitual hyperthermia

Assessment of the Period for Administration of Antibiotics for Primary Atypical Pneumonia

We assessed adequate period for administration of antibiotics for primary atypical pneumonia (PAP). The subjects were patients with PAP admitted to our hospital from January, 1986 to December, 1988. For treatment, 100 mg of minocycline (MINO) was dissolved into 100 ml of solution and infused intravenously for 1 hour twice a day. The patients were divided into two treatment periods: a 6 day-administration group (Group A), and a 9 day-administration group (Group B). Group A: 23 cases (which included 8 cases of mycoplasmal pneumonia) and Group B: 22 cases (which included 10 cases of mycoplasmal pneumonia). A comparative assessment was made between Groups A and B regarding body temperature, WBC, erythrocyte sedimentation rate, CRP and chest X-ray on the 3rd, 6th and 9th days of treatment but no significant difference was observed. Residual shadows at the discontinuance of treatment were present in 61% of Group A and in 36% of Group B but they disappeared gradually in both groups. No recurrent cases were observed in either Group A or B within 1 month after treatment was finished. As for the PAP treatment period using an intravenous drip infusion of minocycline, no significant clinical difference was observed between administration for 6 and 9 days, suggesting that the 6 days administration suffices for treatment. Even though the possible bacterial residue was unknown as no separation of mycoplasma pneumoniae was attempted, there were no recurrent cases

Serum Concentration of Flomoxef in Administration of One Hour Infusion Every Eight Hours a Day

Flomoxef (FMOX) is a new, parenteral oxacephem antibiotic with strong, broad-spectrum antimicrobial activity. To compensate for short half time of this drug, multi-divided administration of the drug was attempted, and the concentrations of FMOX in the blood were determined. The treatment by dripping intravenous infusion of FMOX thrice daily or one hour infusion every eight hours were carried out in six patients with an indwelling intravenous catheter. Four patients had pneumonia and the other two suffered from respiratory infections with lung cancer. With the patient\u27s permission, six blood samples were drawn from each patient just before and after infusions, and the concentration of FMOX was determined by bioassay. The mean serum concentration in the six patients ranged between three troughs just before infusion and three peaks just after infusion, being 1.40 μg/ml, 2.59 μg/ml and 1.84 μg/ml, and 47.32 μg/ml, 52.17 μg/ml and 50 μg/ml, respectively. These concentrations, even troughs, were higher than the MIC90 of almost all bacteria considered to be sensitive to FMOX. In fact, five out of six patients showed a good response to this treatment. No side effects were observed, except mild and transient elevation of transaminase in one case. In conclusion, we recommend the administration of FMOX thrice daily for patients with severe pulmonary infections, especially from the standpoint of its blood concentration

Primary Care Education at Kawasaki Medical School

Department of Primary Care Medicine was established in 1981 at Kawasaki Medical School as a first place to educate students about primary care in Japan. Since the history of Department of Primary Care Medicine is so short, many problems which should be resolved were left over. Brief history of primary care activities in Japan was reviewed and strategies for primary care education were discussed