われわれは前立腺肥大症患者98例を,リスク群(術前尿路感染症を有する患者および糖尿病患者)と非リスク群とに分け,経尿道的前立腺切除術(TURP)後感染症に対する経口剤の予防的効果を検討した.術後急性期(手術日を含め7日以内)の化学療法は,リスク経口群(Ia群)ではlevofloxacin(LVFX)600mg/日を7日間,非リスク経口群(IIa群)ではLVFX400mg/日を2日間およびLVFX200mg/日を5日間投与した.対照として,リスク点滴静注群(Ib群)および非リスク点滴静注群(IIb群)では2日間のみ抗生剤の点滴静注を行い,3日から7日までは経口群(IaおよびIIa群)と同様とした.また創傷治癒期(術後7日目以降)には,4群ともにLVFX100mgを就寝前に1回服用させ,膿尿が白血球10コ/high power field以下になるまで継続した,感染症については,38.0℃以上の発熱および尿路性器感染症の有無を検討した.急性期感染症を示した症例は,Ia群(n=11):9.1%,Ib群(n=16):18.8%,IIa群(n=39):15.4%,IIb群(n=32):12.5%であった.創傷治癒期感染症は,検討できた63例のうち,リスク群(Ia+Ib群,n=15):20.0%,非リスク群(IIa+IIb群,n=48):16.7%であった.術後急性期における経口抗菌剤LVFXによる化学療法は,リスク症例,非リスク症例ともに,注射用抗生物質を併用した群に比べ感染症発症頻度に有意差を認めず,有用であった.また創傷治癒期においても,LVFXの少量就寝前1回投与法は,安全で有用であると考えられた.Recently, oral antibiotics have been evaluated in place of parenteral antibiotics for prophylactic chemotherapy against infections after transurethral resection of the prostate (TURP). We studied the prophylactic effect of levofloxacin (LVFX) on infections following TURP in 98 patients with prostatic hypertrophy. The subjects were divided into a high-risk group (patients with preoperative urinary tract infection and/or diabetes mellitus) and a low-risk group. For postoperative acute-phase prophylaxis (within 7 days of surgery), 600 mg/day of LVFX was administered orally in the high-risk oral group (Group Ia) and 200～400 mg/day was given in the low-risk oral group (Group IIa). A parenteral antibacterial agent was initially administered for 2 days in the high-risk intravenous group (Group Ib) and the low-risk intravenous group (Group IIb), after which they subsequently received the oral LVFX regimens mentioned above. In the healing phase (from postoperative day 8 onwards), 100 mg of LVFX was administered orally before bedtime until the disappearance of pyuria (less than 10 WBC/HPF) in all groups. The percentage of patients with acute phase infection was 9.1% in Group Ia (n=11), 18.8% in Group Ib (n=16), 15.4% in Group IIa (n=39), and 12.5% in Group IIb (n=32). The percentage of patients with healing phase infections was 20.0% in the high-risk group (Ia+Ib, n=15) and 16.7% in the low-risk group (IIa+IIb, n=48). Oral LVFX therapy was useful for the prevention of acute phase infections in both the high-risk group and the low-risk group. In addition, administration of a low dose of LVFX once before bedtime was safe and useful for prophylaxis in the healing phase after TURP
