[Fast diagnostic tests in the management of group A beta-heamolytic streptococcal pharyngitis]. / Tests de diagnostic rapide dans la prise en charge des angines à streptocoques bêta-hémolytiques du groupe A.

OBJECTIVE: Routine clinical diagnosis of Streptococcus pyogenes in pharyngitis is not always easy. The use in common practice of rapid diagnosis test (RDT), might offer a best control of the antibiotic treatments. The aim of this study is to present seven rapid diagnosis tests, to assess their feasibility and finally to determine the bacteriological correlation. METHOD: We propose to compare the results obtained with seven RDT, and to assess their interest in medical diagnosis for group A streptococcus pharyngitis. A prospective study was conducted for three months, a RDT was performed for children (n=75) between eight and fourteen years old presenting acute pharyngitis. Several throat sampling were performed to order cultures. RESULTS: The group A streptococcus was isolated in 33% (n=25) of throat sampling. Comparing cultures results, and for all studied tests, we obtained comparable performances with manufacturer data, specificity upper than 94% and sensitivity upper than 88%. CONCLUSION: All assessed RDT may offer to physicians a decision-making tool for rapid diagnosis. However, because of its complexity, the agglutination test can be used only in pathology laboratories.

[Drug expenses from anesthesiologists]. / Dépenses médicamenteuses induites par les médecins anesthésistes-réanimateurs.

OBJECTIVES: To assess expenses generated by prescriptions from anaesthesiologists in the operating theatre, recovery rooms, surgical intensive therapy units, postoperative care on surgical wards (digestive surgery, orthopaedics, gynaecology, obstetrics, paediatric surgery). METHODS: Prospective study (one year) with evaluation of the costs induced by intravenous and volatile anaesthetics, morphinic and non morphinic analgesics, neuromuscular blocking agents, crystalloids, antibiotics, intravenous nutrient solutions, blood substitutes, anticoagulants, vitamins and vasoactive drugs. RESULTS: The expenses resulting from these prescriptions reached the quarter of the total drug hospital budget. They were equally distributed between anaesthesia and intensive therapy units on the one hand and postoperative care on surgical wards on the other hand. Intravenous anaesthetic agents, antibiotics, crystalloids, represented each one more than 10% of the total cost. CONCLUSIONS: This study demonstrates the weight of prescriptions by anaesthesiologists in the hospital budget. At our hospital, it was mainly due to their activity outside the operating theatre, especially on surgical wards. Therefore anaesthesiologists are essential partners for the elaboration of a cost containment policy.

Stability of nystatin in mouthrinses; effect of pH temperature, concentration and colloidal silver addition, studied using an in vitro antifungal activity.

Alkaline low concentration nystatin mouthrinses extemporanely prepared can be used to treat oropharyngeal candidiasis in immunodeficient patients. However, their expiration dates are not distinctly determined. The stability of nystatin, added (as Mycostatine) at a concentration of 14,400 U/ml in 10-4N hydrochloric acid, purified water and 1.4% injectable sodium hydrogen carbonate with or without 0.002% colloidal silver (an antiseptic agent added because of its known antifungal potency) was studied after storage in tinted glass bottles at 5 degrees C and 22 degrees C over 11 days, and compared with reconstituted 100,000 U/ml aqueous Mycostatine oral suspension. At 2, 4, 7, 9, and 11 days after preparation. Samples were tested for pH, microbial contamination, and assayed by an in vitro microbiological test. Neither significant variation of pH nor microbial contamination were in evidence. Nystatin 14400 U/ml maintained at least 90% of its initial concentration for 4 days in acid at both temperatures, for 7 days (5 degrees C) and 4 days (22 degrees C) in aqueous and alkaline environments, for 9 days (5 degrees C) and 7 days (22 degrees C) in 1.4% injectable sodium hydrogen carbonate containing colloidal silver which showed an antifungal potency. The 100,000 U/ml aqueous Mycostatine oral suspension was stable for 9 days and 4 days at 5 degrees C and 22 degrees C respectively. An ambulant patient can keep a low concentration alkaline antifungal mouthrinse at home for a week at 5 degrees C.

Ganciclovir ophthalmic gel in herpes simplex virus rabbit keratitis: intraocular penetration and efficacy.

A chronic administration of three ganciclovir gels (0.2%, 0.05%, 0.0125%) was compared with a placebo gel and a 3% acyclovir ophthalmic ointment in the treatment of HSV-1 rabbit keratitis. All the ganciclovir gels showed a clinical efficacy: a significant reduction of the corneal ulcer area, clouding and vascularization (p < 0.05) and a fast inhibition of HSV isolates into tear film with the 0.2% and 0.05% ganciclovir gels. However the efficacy was slower than using acyclovir ointment. No significant difference could be shown between the 0.2% and 0.05% ganciclovir gels or the 0.05% ganciclovir gel and the acyclovir treatment on viral isolation, when it was performed on pooled samples. The distribution of ganciclovir and acyclovir into the rabbit eyes (HPLC methods), were similar but markedly higher in solid tissues than ocular fluids. It might explain the recovery from tissue damages. The mean corneal ganciclovir concentrations were largely higher than ED 50 of ganciclovir for HSV-1. No toxicity was expected, due to very limited systemic availability. This study suggests a comparable activity on HSV-1 superficial keratitis between 0.05%, 0.2% ganciclovir gels and 3% acyclovir ointment. Higher concentration of ganciclovir gels are probably necessary in order to treat the HSV-1 kerato-uveitis.

Pharmacokinetics of glafenine and glafenic acid in patients with cirrhosis, compared to healthy volunteers.

Pharmacokinetic parameters were evaluated in 12 patients with alcoholic cirrhosis and 12 healthy volunteers after a single 400 mg oral dose of glafenine. Glafenine (G) and its major active metabolite glafenic acid (GA) were measured at regular intervals using a specific high performance liquid chromatographic method. Glafenine absorption was significantly delayed in cirrhotic patients (CP) (Tmax = 2.8 +/- 1.3 hvs 1.5 +/- 0.4 h, p less than 0.01) and was dramatically reduced in 3 patients. The large hepatic 'first pass' effect observed in healthy volunteers was markedly reduced in CP (ratio Cmax GA/Cmax G = 3.6 +/- 2.9 vs 18.9 +/- 9.8, p less than 0.001; ratio areas under the curves AUC GA/AUC G = 2.3 +/- 2.3 vs 18.2 +/- 11.2, p less than 0.001). The elimination half-life of G was prolonged in the CP (13.0 +/- 13.1 h vs 1.5 +/- 0.5 h, p less than 0.01). In CP, GA elimination half-life was increased (12.0 +/- 13.4 h vs 4.3 +/- 1.3 h, NS) but the difference did not reach statistical significance because of large variability. The significant rise of G plasma concentrations (Cmax = 2.2 +/- 2.1 mg/L vs 0.7 +/- 0.2 mg/L, p less than 0.05) and its longer half-life would lead to an accumulation if the usual dosage regimen was prescribed for CP and could result in nephrotoxicity. On the other hand, lower dosage would be ineffective because only GA is active and nephrotoxic. Hence, G should be given with great caution to CP.

The effect of food and antacids on lansoprazole absorption and disposition.

Bioavailability of lansoprazole, a new gastric proton pump inhibitor, was investigated in 12 healthy subjects. Each subject received in random order, lansoprazole (30 mg) alone or associated with standard meal or with antacids (aluminium and magnesium hydroxides) or one hour later than antacids. Lansoprazole and metabolite (sulfone (AG 1813), sulfide (AG 1777) and hydroxylated (AG 1908) metabolites) plasma concentrations were determined using a specific high pressure liquid chromatographic assay procedure, with a limit of detection of 2 ng/ml. The time to peak was significantly later with food (p less than 0.001) and its magnitude was significantly decreased (600 +/- 330 ng/ml vs 1151 +/- 344 ng/ml, p less than 0.001). The bioavailability of lansoprazole was significantly decreased by food, about 27%, (p less than 0.05) and slightly decreased by concomitant administration of antacids (NS), the effect was more pronounced in male subjects (p less than 0.05). Lansoprazole is presented as an enteric-coated granules, the concomitant administration of antacids, increasing the gastric pH, increased the absorption rate of lansoprazole. When antacids were administered one hour before lansoprazole, no effect was observed on lansoprazole bioavailability. This study showed that lansoprazole must be administered in fasting state and not simultaneously with antacids.

Pharmacokinetics of ofloxacin after single and multiple intravenous infusions in healthy subjects.

The pharmacokinetics of ofloxacin were investigated in eight healthy male volunteers. A single infusion (200 mg over 0.5 h) was performed on day 1, followed by a washout period of 2 weeks. Repeated administrations were performed for 4 days (200 mg every 12 h). Pharmacokinetic parameters were determined from the plasma decay curves of the single and the last of the multiple administrations. Ofloxacin kinetics after the single dose were best described by a two-phase curve with a total body clearance of 241.6 +/- 43.3 ml min-1, a volume of distribution of 112 +/- 23.1 liters, and an elimination half-life of 5.4 +/- 0.8 h. The extrapolated area under the curve (AUC0-infinity) was 14 +/- 2.3 mg.h liter-1. The pharmacokinetics were not significantly modified by repeated administration, demonstrated mainly by the AUC0-12 value of the last infusion (13.4 +/- 2.2 mg.h liter-1). We conclude that, with intravenous multiple doses every 12 h, the steady state is reached within 24 to 36 h and no abnormal accumulation or changes in pharmacokinetic parameters occur.