Comparison of costs linked to the preparation and administration of fluorouracil as a continuous infusion based on three techniques.

The approach in treatment in medical oncology and particularly in the management of solid tumours has to integrate--at least--two targets: the enhancement of therapeutic efficacy, and the respect of global budget assigned to health. Different teams are implicated in such an approach and especially physicians and pharmacists. We decided to conduct a comparative study of three techniques of administering drugs as a continuous infusion. We analysed time and materials required for the preparation in the centralized preparation unit, and for dispensing and nursing in the health units. The use of programmable pumps (CADD-1) leads to overall saving costs of 27 to 40% compared to administration by means of an infusion bag or a motor-drive syringe.

Timing of antibiotic prophylaxis with cefotaxime for prostatic resection: better in the operative period or at urethral catheter removal?

There are two critical moments for the development of severe infectious complications following transurethral prostatectomy (TURP): the operative and immediate postoperative periods, and the day that the postoperative drainage catheter is removed. To optimize the timing of antibiotic prophylaxis with cefotaxime, two prospective randomized studies were conducted in patients with preoperatively sterile urine. In Study 1, all patients (n = 50) received cefotaxime 1 g intramuscular (i.m.) 1 hour preoperatively and were then randomized to receive either a second identical dose of cefotaxime 1 hour before catheter removal 24 hours later, or no further antibiotic treatment. In Study 2, patients (n = 89) were randomized to receive either cefotaxime 1 g i.m. 1 hour preoperatively or no preoperative antibiotic, after which all received cefotaxime 1 g i.m. 1 hour before catheter removal. Results were compared using identical evaluation criteria for infection in both studies: incidence of fever (temperature > 38 degrees C), bacteriuria (10(5) organisms/mL) and positive blood cultures, and duration of hospital stay (days). In Study 1, infection was significantly reduced with respect to all parameters in the group receiving two doses of cefotaxime, and total drug treatment costs were halved. In Study 2, the groups did not differ with respect to any parameter. We conclude that a single dose of cefotaxime 1 g i.m. 1 hour preoperatively provides inadequate cover for urethral catheter removal 24 hours later, and that prophylaxis with a single dose of cefotaxime 1 g i.m. 1 hour before catheter removal is just as effective as two doses given 1 hour preoperatively and 1 hour before catheter removal. Prophylactic coverage is essential during the action of removing the catheter and the time immediately following the operation. Long-term antibiotic coverage (24 hours or more) is not necessary. Thus, following TURP in patients with preoperatively sterile urine undergoing continuous bladder irrigation for 24 hours postoperatively, the optimal dose schedule for antibiotic prophylaxis with cefotaxime is a single 1-g dose given i.m. 1 hour before catheter removal.

Centralized preparation of hazardous drugs. A choice between isolator and laminar airflow.

In 1987, the manager of the Saint-Joseph Hospital (Paris, France) requested a reorganization of cytotoxic drug preparation. Protection for staff who handle hazardous drugs was the main concern. The conclusions drawn from a first analysis emphasize the advantages of a centralized reconstitution unit against a decentralized system. Subsequently, a workload study and an economic study (investment, maintenance, supplies, staff costs, comparative balance sheet and a 5-year simulation) were carried out, but to choose between a laminar airflow in aseptic room and an isolator in a conventional room. The selected isolator is the first of the conception: the central half-suit uses as a server, and four sleeves located on one side allow two technicians to work in a sterile and closed area without sterile garments.

[Prospective evaluation of modalities of ceftazidime prescription]. / Evaluation prospective des modalités de prescription de la ceftazidime.

Between November 1987 and October 1988, we have prospectively studied 101 hospital prescriptions of ceftazidime, a third generation cephalosporine, including all the health care departements of St Joseph hospital. A standard questionnaire was used to collect the date: dosage, length, and conditions of prescriptions. We observed that this antibiotic is correctly prescribed concerning dosage, length of prescription, and is adapted to bacteriological findings. The striking results were a high proportion of empirical prescriptions (48%) comparing to less than 10% 6 months before the beninning of this study. 75% of these empirical prescriptions being later on confirmed by bacteriological exams.

[Prompt antibiotic prophylaxis in resection of the prostate and removal of the bladder catheter]. / Antibioprophylaxie ponctuelle lors de la résection de la prostate et de l'ablation de la sonde vésicale.

Several regimens of antibiotic prophylaxis have been used in transurethral prostatic resection. In this study 50 patients received 1 g of cefotaxime during resection and thereafter were divided at random into two groups: one group received another 1 g dose of cefotaxime when the bladder catheter was removed, while the other group was left untreated at that stage. The administration of cefotaxime during both prostatic resection and catheter removal resulted in a highly significant reduction of infection risk, duration of hospitalisation and cost of antibacterial treatment. The most important risk of sepsis seems to be related to an apparently innocuous procedure: removal of the bladder catheter with resumption of spontaneous micturition.