[Off label uses of tigecycline]. / Les utilisations hors-autorisation de mise sur le marché de la tigécycline.

INTRODUCTION: Tigecycline is a relatively new antibiotic that have very limited valid indications. When no other alternative is available, this drug is widely used off label with promising results. The objective of this study is to summarize the different off label uses of tigecycline so that we can decide when and how to prescribe it in the absence of guidelines. MATERIAL AND METHODS: This study a revue of the literature collecting all the articles concerning the off label uses of tigecycline. RESULTS: Tigecycline was widely prescribed, off label, to treat infections with controversial results. Randomised clinical trials were conducted to evaluate its use to treat pneumonia. The results for this indication have a respectable level of evidence. For the other indications, the data collected was insufficient to support tigecycline prescription. In fact, different protocols were used which makes it hard to evaluate the efficacy and to conclude to the best treatment regimen. A tendency to prescribe high doses of the molecule was noted in different studies. When prescribed off label, tigecycline prescriptions were associated with a higher mortality and incidence of side effects. CONCLUSION: The tigecycline remains a valid option for the treatment of infections dues to multi-resistant bacteria especially when other alternatives are scarce or in cases of renal failure.

[Preloading with HES 130/0.4 versus normal saline solution to prevent hypotension during spinal anaesthesia for elective caesarean section]. / Préremplissage par HEA 130/0,4 versus sérum salé isotonique dans la prévention de l'hypotension au cours de la rachianesthésie pour césarienne programmée.

OBJECTIVE: To evaluate the efficacy of HES 130/0.4 preload compared to normal saline solution for prevention of hypotension during spinal anaesthesia for elective caesarean section. STUDY DESIGN: Prospective, randomized. PATIENTS AND METHODS: Sixty ASA I patients scheduled for elective caesarean section were randomized to receive either 1000 mL of normal saline solution preload (Group C) or 500 mL of HES 130/0.4 preload (Group V) within 15 minutes prior to spinal anaesthesia. Spinal anaesthesia techniques and ephedrine administration was standardized in both groups. The primary endpoint was the incidence of maternal hypotension before fetal extraction. RESULTS: The incidence of hypotension before fetal extraction was significantly lower in group V compared to group C (40% vs 66%, P=0.03). Ephedrine consumption was significantly lower in group V (7.6 ± 13 mg vs 16.4 ± 15 mg). Lowest systolic blood pressure was significantly higher in group V (96 ± 14 vs 85 ± 14 mmHg, P=0.005). Incidence of adverse maternal effects and neonatal consequences were similar in both groups. CONCLUSION: HES 130/0.4 preload reduced the incidence of hypotension, the duration of longest hypotension, and the need for ephedrine during spinal anaesthesia for elective caesarean section. However, the efficacy of HES 130/0.4 alone in prevention of maternal hypotension during spinal anaesthesia for caesarean section is still insufficient.