[Pharmacoepidemiology of diabetes: assessment of good use of oral antidiabetic drugs]. / Pharmacoépidémiologie du diabète : évaluation du bon usage des antidiabétiques oraux.

Diabetes' treatment is specific; therefore diabetic patients can be identified by the prescription of antidiabetic drugs. This pathology is characterized by chronicity and occurrence of complications which need additional medications. All the drugs have official use guidelines due to drug interactions and/or physiological status of the patients. To evaluate how these guidelines are followed in general practice, we used a data base from the French Health care System. Two thousand eight hundred and ninety eight (2 898) prescriptions on which, at least, one oral antidiabetic drug was noticed, were analysed. The number of drugs on each prescription was between 1 and 18 (mean (5,6 +/- 2,9)). Considering the drugs which need precautions of use in association with sulfonylureas, coprescription occurred with B-bloquants and non steroid anti-inflammatory drugs in 18 and 17 % of the cases respectively. The drugs which need precautions of use in association with biguanides were diuretics, oestrogens and/or progestatives and steroids, coprescribed in 28, 1, 1 % of the cases respectively. Percentages of coprescriptions which need precautions of use were quite high. The relevance of detected coprescriptions. and the compatibility between recommendations for "good prescription" and "real prescription practice" should be taken into account considering diabetic patients' characteristics.

[Prevalence of Clostridium difficile and toxin A in feces of HIV infected patients]. / Prévalence de Clostridium difficile et de la toxine A dans les selles de patients VIH positifs.

Patients with AIDS are immunodeficient, receive multiple antibiotic treatments, occasionally anti-cancer chemotherapy and are often hospitalised; thus they are susceptible to develop a Clostridium difficile infection. The aim of this study was to evaluate the role of C. difficile in diarrhoea in this patient population. Therefore, C. difficile and toxin A which plays a major role in pathogenicity were examined in faecal samples of HIV infected patients. Between January 1991 and June 1992, 102 stool samples from 67 patients were studied. Ninety p. cent of these patients were hospitalised (length > 3 days), 80% had a diagnosis of AIDS stage IV, and 66% had diarrhoea. Nineteen point four p. cent of the patients were carriers of C. difficile. Different associations were found: 1) presence of non toxigenic strains and absence of toxin A in stool samples (6 patients), 2) presence of toxigenic strains and absence of toxin A in stool samples (6 patients), 3) presence of toxigenic strains and toxin A in stool samples (2 patients). None of the patients developed a colitis or pseudomembranous colitis. The carrier rate was identical to those found in other hospitalised populations without AIDS. The prevalence of C. difficile diarrhoea or colitis is low. In this study, AIDS patients do not seem to constitute a risk group for C. difficile intestinal pathology. However, carriers of C. difficile were subjected to strict hygiene rules to prevent nosocomial spread.