Medicines and breastfeeding: assessing the risk of medicines to infants

Milk, in addition to its undeniable nutritional and immunological benefits, is an important element for the development of the infant. Warnings, sometimes exaggerated, may prevent the mother and child from enjoying the benefits of both breastfeeding and appropriate medication. This approach is justified by the total absence of investigations on the excretion of drugs in breast milk during clinical trials. The actual risk was evaluated by several classifications; an estimate of the passage of drugs into milk and estimation of infant exposure to the drug are possible and can provide a reliable indicator to better judge the risk to the infant generally we are faced with two different situations: a new treatment during lactation or maintenance treatment already prescribed during pregnancy. If treatment needs to be prescribed for a long period of breastfeeding, a strategic approach is required

Introduction of pharmacovigilance in a new university hospital in Morocco: how and why

In an effort to improve patient safety, Hassan II hospital in Fez introduced a pharmacovigilance system for notification of adverse drug reactions as a priority objective. The implementation of pharmacovigilance activities actually began in June 2007 but it was in 2009 after the inauguration of the new complex that the system became properly operational. This report outlines the activities carried out to develop and implement this system, including informing and training the health professionals, and the results obtained after its introduction. From 2007 to 2009, fewer than 100 cases of adverse drug reactions were reported. Up to June 2011, however, 520 reports of adverse drug reactions were recorded. The classes of drugs most implicated in adverse events were: cancer drugs [26%], anti-inflammatory drugs and antibiotics [each 15%], analgesics [12%], iodinated contrast agents [6%], and anticoagulants and corticosteroids [5%]. The main adverse events were dermatological and 27% of reports came from the internal medicine department, followed by hepatogastroenterology [25%]. Of the 520 cases reported, 46% were severe

[Iodinated contrast induced acute renal and meningo-encephalitis]

The aim of this work is to report the cases of iatrogenic acute renal failure which has occurred after emergency realization of a cerebral scanner, with injection of iodinated contrast product at patients contracted by the meningoencephalitis. This prospective work was realized in a medical intensive care unit between January 2002 and December 2008. The criterion of principal judgment was the creatinin rate variations [>25% of its basic value] in the three weeks after a cerebral scanner with injection of iodinated contrast product at patients contracted by the meningoencephalitis. Eight patients were included among 360 meningoencephalitis cases corresponding to an incidence of 2.2%. The middle age was 43 +/- 17 years. The average time of appearance of the acute renal failure was 43 +/- 17 hours, with an average creatininemia of 66,8 +/- 37 mg/l. Three patients died. The incidence of this undesirable event remains weak but deserves a special attention. An adequate rehydration, before all using of the cerebral scanner with injection, should be realized for any patient presenting a meningoencephalitis

Prevalence of antitiuberculous drug-induced cytolytic hepatitis of tuberculous meningitises

The aim of this work was to specify the prevalence and the description of scondary cytolytic hepatitis of the antituberculous drugs used in treatment of tuberculous meningitis in the intensive care units. Method: We have been included retro-spectively [January 1998 - December 2002] patients having a tuberculous meningitis treated with antituberculous drugs who developed a cytolytic hepatitis defined by an increase of the alanin-aminotransferase [ALAT] level more than two times of its normal upper limit. Six cases have been included among 74 patients [prevalence of 8,1%], three women and three men aged 17 to 45 years. The delay of apparition of cytolytic hepatitis varied from four days to five weeks. ALAT rates varied from two and half to 26 times the normal level. No other potentialy hepatotoxic medication has been prescribed. Three patients normalized their ALAT after reducing the rifam picin dose to half measure, in another case a definitive stoppage of isoniazid was required. Ytolytic hepatitis regressed spotaneously in one patient whereas another died as a result of a nosocomial infection. The prevalence of secondary cytolytic hepatitis of antituberculous drugs during treatment of tuberculous meningitis in the intensive care unit raised to 8,1%, the evolution is most often favourable after adaptation of doses