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Introduction Depuis 2013, les C3G font partie de la liste d’antibiotiques dit « critique » publiée par l’Agence nationale de sécurité du médicament (ANSM) dans le plan national antibiotique. Dans le contexte d’épidémie à entérobactérie productrices de bêta-lactamases à spectre étendu (BLSE), l’utilisation des C3G au cours des PAC doit être réservée à des situations spécifiques (gravité, allergie non grave aux pénicillines…). Matériels et méthodes Étude monocentrique rétrospective sur l’année 2015, sur 40 dossiers tirés au sort, chez des patients ayant reçus au SAU un diagnostic de PAC et la prescription de C3G dans les 48 h de leur admission. L’audit a réuni une équipe pluridisciplinaire (urgentistes, infectiologues, réanimateurs, pneumologues, pharmaciens) afin de créer un référentiel local sur les indications des C3G au cours des PAC et d’évaluer la conformité de la prescription des C3G pour chaque dossier sélectionné grâce à l’étude des données cliniques, biologiques et radiologiques. Résultats En 2015, 749 patients ont eu un diagnostic de PAC au SAU, et sur ces 749 patients, 218 ont reçu des C3G dans les 48 h. Sur les 40 patients sélectionnés tirés au sort, la pertinence de prescription de C3G était de 62,5 % (25/40). Le diagnostic de PAC a été finalement retenu par l’audit pour 24 patients sur 40. Parmi ces 24 patients, 87,5 % (21/24) ont eu une prescription de C3G retenue comme pertinente (15 sur la sévérité et 6 sur la notion d’allergie aux pénicillines). Concernant les 16 dossiers pour lesquels le diagnostic de PAC n’était pas validé, le taux de pertinence n’était que de 25 % (4/16), dans un contexte toujours polypathologique avec des diagnostics difficiles. Conclusion Dans cet échantillon de 40 patients, 37,5 % des prescriptions de C3G ont été jugées comme non pertinentes (dans leurs indications), mais le taux s’élève 75 % lorsque le diagnostic de PAC n’est pas formellement établi. L’audit révèle l’importance d’une action d’amélioration : diffusion des indications des C3G dans les PAC au sein de l’établissement et encouragement aux examens complémentaires dans les situations critiques de diagnostic difficile. [ABSTRACT FROM AUTHOR]

Aim: Acetaminophen is widely used in hospital settings and often considered as nontoxic. We conducted a multicentric study in order to evaluate its proper use., Method: Prescriptions from five general hospitals were analyzed, according to dose adjustments required in renal or liver failure, weight or chronic alcoholism, determined using a literature review. Other criteria have been assessed: indication for parenteral access, accuracy of administration time and pain assessment., Results: Among the 1256 analyzed prescriptions, 21% are non-compliants. The main causes of non-compliance (NC) are adjustments to weight and renal failure. Higher NC rates concern chronic alcoholism and liver failure., Conclusion: Misuse of acetaminophen seems related to a lack of official recommendations concerning dose adjustments. Hospital pharmacists have an important role to play in the promotion of proper use of acetaminophen. Therefore we established a prescribing aid., (Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: By the Order of 6 April 2011, the pharmacist must validate all the prescriptions containing "high-risk drugs" or those of "patients at risk". To optimize this clinical pharmacy activity, we identified high-risk drugs., Method: A list of high-risk drugs has been established using literature, pharmacists' interventions (PI) performed in our hospital and a survey sent to hospital pharmacists. In a prospective study (analysis of 100 prescriptions for each high-risk drug selected), we have identified the most relevant to target., Results: We obtained a statistically significant PI rate (P<0.05) for digoxin, oral anticoagulants direct, oral methotrexate and colchicine., Conclusion: This method of targeted pharmaceutical validation based on high-risk drugs is relevant to detect patients with high risk of medicine-related illness., (Copyright © 2016 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Vasoconstrictors, widely prescribed in the congestive states during acute rhinitis, are responsible for many cases of drug-related iatrogenic disease., Case Report: We report the case of a 40-year-old man, who presented with an episode of malignant hypertensive crisis associated with life-threatening congestive heart decompensation. The patient interview revealed consumption to supra-therapeutic dosage of an association of naphazoline and prednisolone nasal sprays. The diagnostic work-up allowed to rule out disease-related causes of secondary hypertension. The drug-related disease was thus retained., Conclusion: The results of the literature review showed many cases of vasoconstrictor poisoning responsible for central nervous system and cardiovascular involvement, especially in young children. This first case of heart failure related to nasal decongestant administration increases the scope of potentially serious risks of these drugs and demonstrates the outreach needs for health professionals and patients about their proper use., (Copyright © 2015 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Aim: Oral mucositis is a very common complication of allograft. However, preventive treatments are still limited. The objective of this study is to identify risk factors for onset of oral mucositis in patients undergoing allogeneic hematopoietic stem cells transplantation (HSCT), to measure clinical consequences and to study their evolution according to type of prevention., Patients and Methods: All patients undergoing HSCT in hematology unit of CHU Besançon between January 2009 and August 2010 were included, and received according to their choice, either the standard protocol: solution of sodium bicarbonate 1.4% associated with chlorhexidine-chlorobutanol (Eludril(®)) (n=49), or the experimental treatment by the ionic solution, Caphosol(®) (n=42)., Results: The overall incidence of severe mucositis and mucositis is respectively 69% and 36%. In multivariate analysis, a myeloablative conditioning (OR=11.1) and prevention of GVHD (graft-versus-host disease) including methotrexate (OR=7.5) appear such as the two significant mucositis risk factors. The presence of mucositis resulting in a significant increase in the incidence of febrile aplasia (P=0.008) and the use of opioid analgesics and parenteral nutrition (P<10(-3)). The risk of acute gastrointestinal GVHD is also increased in severe mucositis (P=0.01). The duration of post-transplant hospitalization is not changed. The type of prevention does not influence the incidence of mucositis (P=0.11)., Conclusion: The consequences of mucositis are significant and the risk factors identified. The interest of the ionic solution Caphosol(®) seems limited, the incidence of mucositis is not decreased by this prevention., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Posaconazole (PSZ) is being used for prophylaxis in hematological patients who are at high risk for invasive fungal disease (IFD), but absorption limitations have been reported. Our objective was to assess both the feasibility and the efficacy of PSZ prophylaxis in clinical practice. From March 2010 to September 2010, all patients admitted to our unit for chemotherapy for acute leukemia or hematopoietic stem cell transplantation received optimized PSZ prophylaxis 200 mg four times daily with cola soda. PSZ trough concentrations (Cmin) were monitored at days 5, 7, 14, and 21. The incidence of IFDs was determined and compared to that of a historical control group. Thirty-five consecutive patients were prospectively included. PSZ prophylaxis was interrupted for 29% of them at day 14 and 51% of them at day 21. The main limitations were impracticality of oral feeding (29%) and occurrence of suspected IFDs (23%). PSZ median Cmin were 0.47, 0.40, 0.24, 0.36 μg/mL at days 5, 7, 14, and 21, respectively. Eighty percent of patient results were lower than the target Cmin of 0.5 μg/ml on day 14, the higher-risk period associated with neutropenia. Four probable breakthrough IFDs (11%) were diagnosed in 2010; no clear association between PSZ Cmin and occurrence of infection was observed. The incidence of IFDs was unchanged (historical control group: 9.7%; P = 0.72). Implementation of systematic PSZ prophylaxis did not significantly decrease the incidence of IFDs at our center. PSZ interruptions related to mucositis and too low Cmin were the main limitations to its use., (© The Author 2014. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Drug repackaging in pill-box by pharmacists is booming since few years. However, repackaging processes needed to open the industrially primary packaging will be found illegal in France. Thus, in this country drug repacking remains legal only by overwrapping medicines. Now, this solution is not applicable for example, with divisible or liquid forms. Therefore, packaging recommendations must be taken immediately in order to preserve the quality of drugs dispensed and to obtain a legalization of this activity., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objective: Improving the use of antimicrobial drugs is a national objective. To this end an evaluation of clinical practice was implemented on prescribed antibiotics in elderly patients, in the Besançon Teaching Hospital., Design: In 2005, a clinical audit compared the adequacy of antibiotic prescriptions to national guidelines in 37 patients. An improvement plan was implemented, including the drafting of local guidelines (adapted national guidelines) "Antibiotic prescription in elderly patients" by a multidisciplinary team. The Antibiotics Committee approved it. A retrospective study compared antibiotic prescription of 62 patients to these guidelines. The methodology was based on Gyssen's algorithm. The assessment criteria were: relevance of the indication, absence of a better alternative, respect of recommended dose, duration, and timing., Results: The rate of overall conformity was 26% in 2005, 57% in 2007. Antibiotic choice was adequate in 61% of cases in 2005, 78% in 2007. In 63% of cases, a more efficient alternative was advised in 2005, 10% of cases in 2007. Treatment duration, dose, and timing were adequate in 54 - 92 - 96% in 2005 respectively and 86 - 92 - 100% of cases in 2007. Ciprofloxacin was prescribed in first line for 42% of urinary infections in 2005, 0% in 2007., Conclusions: This approach improved antibiotic prescriptions because of better guideline observance by physicians. The main improvement concerned fluoroquinolones. It should be continued to confirm antibiotic good use and protect our hospital bacterial ecology., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)