[Assessment of antibiotic prescriptions in the emergency department of a general hospital. Prospective analysis of 211 prescriptions]. / Evaluation de la qualité des prescriptions antibiotiques dans le service d'accueil des urgences d'un centre hospitalier général. Analyse prospective de 211 prescriptions.

AIM: To study the appropriateness and conformity to antibiotic prescription guidelines in an emergency department and to assess the factors likely to influence them. METHODS: This prospective study included all adult patients visiting the emergency department over a period of 100 days and receiving antibiotic treatment. Two independent specialists in infectious disease assessed the appropriateness of the indications and the treatment's conformity with good practice guidelines. We also studied patient's status 7 days after initiation of antibiotic treatment, duration of hospitalization and any treatment changes. RESULTS: The study included 211 patients, 47% of them men. Prescriptions were appropriate in 53% of cases and in accordance with guidelines in 34%. Half of all prescriptions were related to urinary tract or pulmonary infections. Four antibiotic families accounted for 88% of prescriptions. Prescription errors were related to multidrug treatments, intravenous drugs, and inappropriate antibiotic families. More than half (56%) of the patients were admitted, and 70% of these remained in the hospital more than one week. Duration of treatment was inappropriate for 31% of the patients not admitted. In all, 44% of the antibiotic prescriptions ordered in the emergency department were later modified. CONCLUSION: Multidisciplinary work is essential in improving the quality of antibiotic prescriptions in an emergency department.

A simple two-step approach for introducing a protected diaminedithiol chelator during solid-phase assembly of peptides.

A simple synthetic strategy is described to incorporate a protected diaminedithiol (N(2)S(2)) chelator during Fmoc solid-phase synthesis of short peptides. The resulting constructs could be efficiently labeled with technetium-99m (99mTc). The chelator was assembled at the N-terminus of peptides in a two-step procedure where the deprotected terminal amino group was first reacted with di-Fmoc-diaminopropionic acid (Fmoc-DAP-[Fmoc]-OH). The two protected amino groups were then simultaneously deprotected and subsequently reacted with S-benzoylthiolglycolic acid (TGA) to generate a protected N(2)S(2) chelator. This metal binding site was introduced into di- and tripeptides. Each peptide construct was composed of a C-terminal lysine residue and an N-terminal diaminopropionic moiety modified to create the chelator site. The epsilon-amino group at the C-terminal lysine was further derivatized with a nitroimidazole group to facilitate cellular retention. The resulting constructs were then cleaved from the resin support, purified, and labeled with [99mTc]pertechnetate. Six constructs were prepared differing by a single amino acid inserted between the diaminopropionic acid and lysine residues. Optimal labeling yields of >70% were achieved around neutral pH and heating at 75 degrees C for 10 min. Purified 99mTc-labeled constructs were found to accumulate in Chinese hamster ovary (CHO) cells in vitro as a function of charge and hydrophobicity.