[Adherence between antibiotic prescriptions and guidelines in an internal medicine ward: an evaluation of professional practices]. / Adéquation entre les prescriptions antibiotiques et les recommandations dans un service de médecine interne : une démarche d'évaluation des pratiques professionnelles.

INTRODUCTION: This is an evaluation of professional practices (EPP) on antibiotic therapy in an internal medicine ward. MATERIAL AND METHODS: A 6-month prospective review of antibiotic prescriptions and their comparisons with local and national guidelines (drug, daily dose, administration, and duration) were performed. RESULTS: Antibiotic therapy on 227 infectious episodes was collected. According to local guidelines, we found 56% of totally respected (lower respiratory tract infections: 38%, urinary tract infections: 88% and skin infections: 73%), 33% of partially respected and 11% of non-appropriate prescriptions. Considering national guidelines for lower respiratory tract infections as references, the results were: totally respected prescriptions 81%, partially respected prescriptions 16%, and non-appropriate prescriptions 3%. CONCLUSION: This evaluation of the prescriptions allowed setting up long-lasting actions to improve clinical practice. This approach anticipates the procedures of EPP that will be needed for hospital accreditation and highlights the importance of considering several guidelines for the interpretation of the results.

[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.

The adherence to antiretroviral treatment evaluated from a hospital pharmacy: importance of the protease inhibitors pharmacological class.

The goal of this study was to develop an evaluation method of antiretroviral treatment adherence from a hospital pharmacy and to identify one or more factors that influenced this adherence, such as patient or treatment characteristics. The HIV patients included in this study were based, for the major part, in Saint-André hospital and collected their medication from this hospital pharmacy. They were all delivered a renewable prescription that should have comprised two successive delivery stamps. A total of 186 patients was included. For the adherence analysis, the delay between two successive deliveries was measured. We have specified three different categories of patients: adherent, non-adherent and intermediate, according to a definition of adherence accepted by many authors. We have demonstrated that the only antiretroviral therapeutic class associated with poor adherence was the protease inhibitors, in particular nelfinavir, which requires food to be taken at the time of administration. This can pose difficulties for those patients who lunch at their workplace and consequently affect adherence. This study allowed us to demonstrate that a less subjective adherence evaluation can be easily carried out from a hospital pharmacy.

[Comparison of 2 administration protocols (continuous or discontinuous) of a time-dependent antibiotic, Tazocin]. / Comparaison de deux schémas d'administration (continu ou discontinu) d'un antibiotique temps-dépendant: la Tazocilline.

A predictive parameter of beta-lactam therapeutic efficacy is the time (T > MIC) while antibiotic serum concentrations are above the MIC of suspected bacteriological agents. This led us to carry out a randomised open study to compare the usually used intermittent administration of Tazocin (three injections of 4 g/0.5 g a day) and continuous perfusion of 12 g/1.5 g a day by calculating these T > MIC. Patients from digestive reanimation department were randomised within two arms: continuous or intermittent administration. Sixteen takings of blood were executed over a forty-hour period. After liquid/liquid extraction, piperacillin and tazobactam serum concentrations were determined by HPLC with a reversed phase column (C18) and a UV spectrophotometry detection. Then, from the time-concentration curves we have evaluated the T > MIC for an enterobacteria (MIC = 8 micrograms/mL) and for Pseudomonas (MIC = 16 micrograms/mL). Concerning intermittent administration T > MIC were 74% (c > MICenterobacteria) and 62% (c > MICPseudomonas). These percentages in the continuous arm were 100% (c > MICenterobacteria) and 99% (c > MICPseudomonas). Tazobactam concentrations were low and even undetectable between each injection in the intermittent administration arm. This was not found within the continuous administration arm. In conclusion, for the intermittent administration, we observed some long periods occurring before each injection while antibiotic concentrations were under the MIC of most bacteria. During these same periods tazobactam concentrations were under the efficacy threshold. These periods were not observed within the continuous administration arm.

[Study of the efficacy and tolerance of imipenem-cilastatin used as monotherapy for the adjuvant treatment to surgery of peritonitis. Results of a French multicenter study including 257 patients]. / Etude de l'efficacité et de la tolérance de l'imipénème/cilastatine utilisé en monothérapie dans le traitement adjuvant à la chirurgie des péritonites. Résultat d'une étude multicentrique française auprès de 257 patients.

The antibiotic treatment of peritonitis classically resorts to the association of two and even three molecules. In order to test the efficacy of a single-drug therapy with Tienam* imipenem/cilastatin) as an adjunctive treatment associated to surgery for perforation peritonitis, an open, non-comparative study of 257 patients was carried out in 28 departments. Imipenem is the first beta-lactam antibiotic of the carbapenem family. This antibiotic seems to be particularly useful for the treatment of mixed polymicrobial infections such as peritoneal infections, owing to its activity spectrum covering Gram-positive and Gram-negative, aerobic and anaerobic germs, including strands with multiple resistances (Enterobacter, Pseudomonas aeruginosa, Serratia marcescens, Acinetobacter, Enterococcus and Bacteroides fragilis). A total of 212 patients were assessed with a treatment averaging 7 days. The five most frequently isolated bacteria were Escherichia coli, streptococci, Bacteroides, Proteus and Klebsiella. The healing or improvement rate was 95.3% (202/212). Seven cross-infections occurred during of after the treatment. Tolerance is good in 96% of all cases. Adverse effects were infrequent and mild: the hepatic and hematological alterations never required the interruption of the treatment and they were reversible; the treatment was interrupted in one patient only because of omental tremulation.

Biochemical characterization of a Yucaipa-like virus.

A Yucaipa-like virus (PLOC/Senegal/273/77) was grown in embryonated chicken eggs and used for biochemical investigations after purification. The genome of the virus is composed of one fragment of single-stranded (ss)RNA with an estimated mol. wt. of 5.6 X 10(6). There are six virus structural polypeptides with mol. wt. of 126 000, 68 000 (major), 60 000, 52 000 (major), 44 000 and 39 000 (major). The fatty acid composition of the virus envelope seems to be very selective since we found only fatty acids containing 14 and 16 carbon atoms.

Differences in early ultrastructural aspects of the replication of measles and subacute sclerosing panencephalitis viruses in a cell culture from a human astrocytoma.

Monolayer cultures from a human astrocytoma were infected with small amounts of Mantooth Subacute Sclerosing Panencephalitis (SSPE) and Edmonston measles viruses. The infected cells were studied with an electron microscope 48 hours and 96 hours post-inoculation (PI). By 48 hours PI, both viruses produced syncytia and cytoplasmic inclusions of granular nucleocapsids 20 to 25 nm in diameter which did not differ in appearance. With the Edmonston measles virus granular nucleocapsids assembled into budding particles were found just under the cell membrane while nucleocapsids of Mantooth SSPE virus spared the area under the cell membrane and were not incorporated into budding particles. Inclusions of smooth nucleocapsids, 15 nm in diameter, could be seen within the nuclei of Mantooth SSPE virus infected cells 96 hours PI; such nuclear inclusions were not found in the Edmonston measles virus infected cells. These results are compared with those obtained in other cell systems and are discussed with respect to recent findings in the field of SSPE.