Impact of implementing French antibiotic guidelines for acute respiratory-tract infections in a paediatric emergency department, 2005-2009.

Acute respiratory tract infections (ARTIs) are the main reason for antibiotic prescription in children. In 2005, the French Drug Agency published guidelines to minimise inappropriate use of antibiotics for ARTI. The purpose of this study was to assess the impact of implementing these guidelines in a paediatric emergency department. We retrospectively analysed data collected prospectively in a French paediatric emergency department from November 2005 (date of guideline implementation) to October 2009. For each child diagnosed with ARTI, we collected age, diagnosis, and prescribed antibiotics. We computed antibiotic prescription rates in the study population. During the study period, 53,055 children were diagnosed with ARTI and 59% of the 22,198 antibiotic prescriptions given at discharge were related to ARTI. The proportion of ARTI patients given antibiotic prescriptions fell from 32.1% during the first year to 21% in year 4 (p<10(-4), Cochran-Armitage test). Amoxicillin-clavulanic acid and amoxicillin accounted for 50% and 34% of antibiotic prescriptions for ARTI, respectively. French antibiotic guidelines led to significant decreases in antibiotic prescription for ARTI in our paediatric emergency department.

Molsidomine--an effective antianginal drug. Results of an acute randomized stress-testing study.

The antianginal efficacy of molsidomine (single oral dose of 2 mg), a new antianginal drug, was evaluated in 12 patients with coronary artery disease in a double-blind randomized placebo-controlled study by bicycle ergometry. Besides the standard ergometric parameters, the myocardial efficiency index (MEI) was determined from the ratio of the maximum workload (kgm/min) to double product (mm Hg X min) X 10(-2), normalized for body surface area. Compared to placebo, molsidomine decreased positive exercise tests by 50%, pain response by 66%, and the magnitude of ST depression by 43%. Furthermore, the onset of ergometric positive response was delayed, with an increase in maximum workload achieved (+21%), total work performed (+43%), and duration of exercise (+28%). MEI also increased from 0.98 +/- 0.43 to 1.18 +/- 0.44 (p less than 0.005), due to a significant increase in maximal workload without a parallel increase in double product. These findings suggest that molsidomine is an effective antianginal drug and improves myocardial efficiency in patients with angina due to coronary artery disease.

Hemodynamic effects of molsidomine vasodilatory therapy in acute myocardial infarction.

The hemodynamic effects and duration of action of 4 mg of intravenous molsidomine (M), a new peripheral vasodilator antianginal agent, were evaluated and compared to those of 10 mg sublingual isosorbide dinitrate (ISDN) in 12 patients with uncomplicated acute myocardial infarction (AMI). Both M and ISDN produced marked decreases in mean right atrial pressure (RAP), mean pulmonary capillary wedge pressure (WP), and mean pulmonary arterial pressure. The maximal decreases in RAP (-56%) and WP (-35%) with intravenous M intended to be more pronounced than with sublingual ISDN (RAP-35% and WP-29%). Physiologic modest declines in systemic vascular resistance, cardiac output, and arterial pressure were similar with the both drugs. The duration of action of M was longer (average 5 hours) than that of ISDN (2 hours). No patient experienced hypotension, tachycardia, or other adverse responses following M, suggesting that M is well isolated by patients with normotensive AMI.