Pharmacoeconomic aspects of antibacterial treatment with cefotaxime.

Pharmacoeconomics is a relatively new discipline, which is becoming increasingly useful in the current climate of medical advances that continue despite limited access to healthcare resources. Pharmacoeconomics may be used as a tool, assisting healthcare decision makers to select clinically beneficial therapies and weigh clinical gain against expenditure. Cefotaxime has been shown in many studies to be a cost-effective antibiotic agent, its monetary value being augmented by its use in low dose, low frequency regimens. This cost-effectiveness, combined with a maintained broad spectrum of antibiotic activity, low propensity for selecting resistant bacterial strains and high therapeutic index, makes cefotaxime a suitable antibiotic agent in many indications involving mild-to-moderate infections by susceptible organisms.

Evaluation of drug interaction document citation in nine on-line bibliographic databases.

OBJECTIVE: To compare nine on-line bibliographic databases to obtain bibliographic references on specific drug interactions. DESIGN: Seven bibliographic databases were selected for their ability to provide information concerning drug interactions: EMBASE, MEDLINE, TOXLINE, BIOSIS, Chemical Abstracts (CAS), PHARMLINE, and International Pharmaceutical Abstracts (IPA). Two French on-line bibliographic databases (i.e., PASCAL, BIBLIOGRAPHIF) were also tested to compare them with the other international databases. Twenty drug interactions were selected randomly using the journal Reactions Weekly 1993. MAIN OUTCOMES MEASURES: The total number of references, the number of potentially relevant references, the number of case report references, the number of unique references in the total number of references, and the number of unique references between potentially relevant references were analyzed by using the Friedman two-way ANOVA by ranks. For each database, relevance and relative recall were calculated. RESULTS: For the total number of references, EMBASE was significantly more comprehensive then all other databases (p < 0.05). EMBASE had a significantly greater number of potentially relevant references than IPA, PHARMLINE, CAS, and BIBLIOGRAPHIF (p < 0.05). For the total number of case report references, only one significant difference, between EMBASE and BIBLIOGRAPHIF (p < 0.05), was observed. MEDLINE and TOXLINE had the lowest cost per potentially relevant reference. CONCLUSIONS: To obtain bibliographic references on drug interactions, the first step should be to search MEDLINE or TOXLINE; the second step, for completeness, should be to search EMBASE.

European survey of independent drug information centers.

OBJECTIVE: The purpose of our survey was to ascertain the activities of the independent drug information centers (DICs) in Europe and to contact the person in charge of these services to establish a European network of DICs in the future. DATA SOURCES: The survey was conducted in 32 European countries. We contacted 2026 people in DICs and official healthcare organizations by mail. On request, we returned our questionnaire including 167 closed questions on the means and activities of a DIC. Data were collected and analyzed on a personal computer using dBASE III PLUS (Ashton-Tate). RESULTS: Of the 110 questionnaires received, 88 answered the question pertaining to the number of queries asked of the DIC per year and were analyzed (1 from West Germany, Denmark, Finland, Sweden, Portugal, Poland; 2 from Italy; 3 from Switzerland; 6 from Spain; 8 from The Netherlands; 16 from France; and 47 from the United Kingdom). We recorded data on their location, their means (e.g., staff, information), their users (e.g., health professionals), and activities. CONCLUSIONS: The DICs were located in healthcare structures, managed by pharmacists or physicians, and open to other health professionals. Only the United Kingdom maintains a national organized network. Most of the participants showed interest in cooperating with each other to establish a list of the centers, guidelines on good information practices, a database, and a European network.

Comparison and evaluation of nine bibliographic databases concerning adverse drug reactions.

Few evaluations and statistical comparisons of bibliographic databases have been published. As a drug information center, we were particularly interested in databases providing references on adverse drug reactions (ADRs). Ten drugs were randomly chosen from the 2000 files at our center. Nine databases were selected according to the high frequency of references concerning ADRs: eight online systems (MEDLINE, BIOSIS, TOXLINE, Iowa Drug Information System, PASCAL, EMBASE, PHARMLINE, and International Pharmaceutical Abstracts [IPA]), and one Compact Disk Read Only Memory (CD-ROM) system (Core MEDLINE). The total number of references, the number of references from 1987 to 1989, and the number of relevant references from 1987 to 1989 were analyzed using the Friedman two-way ANOVA by ranks. The overlap between databases for only one drug, carboplatin, and the quality:cost ratio were also studied. Considering the total number of references, TOXLINE and EMBASE were significantly superior to IPA, PHARMLINE, PASCAL, and Core MEDLINE. For the period 1987-1989, EMBASE was significantly superior to PASCAL, IPA, PHARMLINE, and Core MEDLINE with regard to total number of references, and significantly superior to PASCAL, Core MEDLINE, and IPA with regard to relevance. MEDLINE, TOXLINE, and EMBASE had the best quality:cost ratio. EMBASE had the slightest overlap of references, with 53 percent of the unique references on carboplatin. This comparative evaluation showed that the ability of bibliographic databases to provide information on ADRs is dependent on both the size and the quality of each database.

Procedures on handling mifepristone (RU 486) in France.

Mifepristone (Mifegyne 200 mg) is a newly approved drug in France for termination of early pregnancy. Consequently, doctors and pharmacists have to follow strict legal rules of prescription, administration, storage, and dispensing. French requirements are reviewed with particular regard to practical procedures of dispensing.

PIP: The Government of France has developed strict legislation in terms of the manufacture, storage, dispensing, prescription, and administration of RU-486. The drug has been available in France since 1989 under the trade name Mifegyne (Roussel Laboratories). RU-486 has been classified as a contragestive due to its ability to interrupt an early pregnancy. Physicians who prescribe RU-486 as an abortifacient must receive special training from Roussel. Protocol requires that women who request RU-486 must be provided with information about abortion risks and alternatives, undergo a psychosocial evaluation, and be given a 1-week period for decision making. RU-486 must be taken in the presence of the prescribing physician, and can only be administered to women with an intrauterine pregnancy whose last menstrual period was no more than 49 days earlier. 2 days after RU-486 administration, the patient is given a prostaglandin analog (gemeprost or sulprostone) and monitored for at least 3 hours. 8-12 days after RU-486 administration, the woman must be given a follow-up examination to ensure that the expulsion was complete. RU-486 is available only from pharmacies of hospitals that are authorized to perform pregnancy interruption. The drug must be stored in a locked cabinet, and a double counterfoil book is used to control misuse.