[Influence of hospitalisation on the elderly people polypharmacy]. / Influence de l'hospitalisation sur la polymédication des sujets de plus de 60 ans.

INTRODUCTION: The objective of this study was to analyse the influence of hospitalisation on the polypharmacy of elderly people in internal medicine. METHODS: Prescriptions before hospitalisation and after discharge were prospectively collected and analysed. The percentages of pharmaceutical medication classes used before and after hospitalisation were compared using marginal homogeneity's test for paired series. RESULTS: One hundred and sixteen patients (mean age: 79 years) were included in this study. The number of drugs prescribed amounted to 6.4 before hospitalisation and 6.7 at discharge. Hospitalisation did not lead to reduction in the amount of prescribed drugs but some medications were modified. We observed a significant reduction in beta-blockers (25 to 19.8%, P=0.035) and lipid-lowering drugs (21.6 to 15.5%, P=0.058). On the other hand, the laxative medication was increased at discharge (19.8 to 34.5%, P=0.001). Similarly, there was an increase in psycholeptic drugs after hospitalisation (34.5 to 44%, P=0.007). CONCLUSION: These results pointed out firstly the polypharmacy observed in elderly patients and secondly the difficulty to reassess prescriptions. Our results should heighten clinicians' awareness of polypharmacy of elderly patients and of the usefulness of performing an individual assessment of the various drugs prescribed to a patient. The hierarchical organisation of disorders and drugs should allow to optimise the safety of the medications and decrease iatrogenic events.

[Proper use of antibiotics: a prospective study on the use of linezolid in a French university hospital]. / Bon usage des antibiotiques: étude prospective sur l'utilisation du linézolide dans un hôpital universitaire français.

AIM OF THE STUDY: To describe clinical use of a new antibiotic: linezolid, in a French university hospital, on a population of patients different from the one studied during the clinical trials for the marketing authorisation. PATIENTS AND METHODS: An observational, prospective cohort study performed in patients treated by linezolid between November 2005 and June 2006 at Saint André hospital (Bordeaux University Hospital). The following data were collected: sources of infection, isolated pathogens, patient's background, antibiotherapy strategies, duration of therapy and evolution. RESULTS: Fifty patients (intensive care, internal medicine) were included. The absence of local guidelines on proper use of linezolid led to various prescriptions as well in infections listed in the marketing authorisation: nosocomial pneumonia and ventilator associated pneumonia (48%), skin and soft tissue infections (11%), as in endocarditis (7%), intra-abdominal infections (13%), bone and joint infections (2%), catheter infections (13%) and febrile neutropenic patients (6%). The main justification for using linezolid was worsening renal dysfunction (66%), which contra indicated glycopeptides use. Isolated pathogens were for the major part staphylococcus. CONCLUSION: In the context of proper use of antibiotics, it would be advisable to add new recommendations on the use of linezolid to the hospital's antibiotherapy guide which would constitute a tool for the prescribing clinicians, and to re-evaluate the impact during a second evaluation.

[Incidence and reasons of premature discontinuation of abacavir: results of a hospital investigation among 628 patients]. / Incidence et motifs des arrêts prématurés de l'abacavir au cours des deux premiers mois de traitement: résultats d'une enquête hospitalière chez 628 patients.

OBJECTIVE: The aim of this study was to determine the incidence of abacavir discontinuation within the first two months of treatment and the link with a true hypersensitivity reaction (HSR). PATIENTS AND METHODS: A retrospective study was made between January 1998 and January 2006 on a cohort of HIV positive patients treated by abacavir delivered by the Bordeaux Saint-André University Hospital pharmacy. RESULTS: Six hundred (and) twenty-eight patients were included. The reasons for non-renewal of abacavir prescription within the first three months of treatment were investigated. Early discontinuation for adverse effects was reported in 32 patients (5.1%): proved diagnosis of HSR (N=10), uncertain diagnosis of HSR (N=8), and no HSR (N=14). The decision for discontinuation was taken by physician after consultation in 76% of cases.