Antibiotic usage in south-western French hospitals: trends and association with antibiotic stewardship measures.

OBJECTIVES: French hospitals are urged by health authorities to develop antibiotic stewardship (ABS) programmes in order to improve antibiotic use and to decrease their consumption. We performed a longitudinal survey to describe ABS measures implementation and antibiotic use and to study relationships between ABS measures and trends in antibiotic use between 2005 and 2009. METHODS: Data on ABS, antibiotic use and activity were retrospectively collected by questionnaires sent to hospitals voluntarily participating in the south-western France network. ABS measures covered organization, resources, restrictive and persuasive actions. Antibiotic use was retrieved from pharmacy records and expressed as the number of defined daily doses/1000 patient-days according to national and WHO guidelines using 2009 defined daily dose values to monitor trends. Relationships between ABS measures and antibiotic use were studied by multivariate logistic regression. RESULTS: Between 2005 and 2009, the degree of implementation of ABS increased in the 74 participating hospitals. Antibiotic use remained stable, with variations according to hospital groups and antibiotic classes. In hospitals with more ABS measures, antibiotic use in general and fluoroquinolone use tended to remain stable or to decrease. Educational activities were associated with a decrease in fluoroquinolone use in the univariate analysis. In the multivariate analysis, practice audits and time dedicated by the antibiotic advisor were significantly associated with a decrease in total antibiotic use and fluoroquinolone use, respectively. CONCLUSIONS: This first longitudinal study, in 74 hospitals, showed that human resources and persuasive ABS measures, in the context of a multidisciplinary approach, are helpful in controlling total antibiotic and fluoroquinolone use.

[Charter of medicines promotion and rational use by physicians]. / Charte de la visite médicale et bon usage du médicament.

The charter of medicines promotion recently adopted by France intends to constrain information given by sales representatives to the field of good prescription practices. Over a 11 year period (1994 to end 2004), 362 interdictions of promotional supports have been decided by the director of the French Medicines Agency. This accounts for 0.5% of the about 80 800 promotional supports controlled during this period. A date base shows the representation of the justifications of these interdictions and the predominance of documentation given or showed to the physicians. A challenge for health authorities would be to assess the actual impact of ethical and non ethical promotion.

How innovative are pharmaceutical innovations?: the case of medicines financed through add-on payments outside of the French DRG-based hospital payment system.

OBJECTIVE: To analyze the characteristics of inpatient medicines placed on the list of innovative high-cost medicines funded in addition to DRG-based payment, and to identify whether they really are innovative and/or high-cost. METHODOLOGY: The medicines placed on the list of innovative and high-cost medicines were analyzed on the basis of criteria describing their innovative nature and cost. They were categorized as innovative and high-cost, only high-cost, only innovative and neither innovative nor high-cost. RESULTS: Among the medicines financed in addition to DRG-based payment, 25.5% were classified as innovative and high-cost, 23.5% only high-cost, 22.9% only innovative and 28.1% neither innovative nor high-cost. CONCLUSIONS: The list of innovative and high-cost medicines contains medicines other than innovative and high-cost medicines. Stricter criteria for placing medicines on this list should be considered in order to limit the increase in expenditure.

Medicines submitted to narcotics regulations in France, 1992-2007.

The objective was to study the current narcotics regulations which are the most restrictive regarding prescription and dispensation practice in France, and their evolution over the period 1992-2007. This is an example of regulation in a European member state regarding medicines with a risk of abuse or dependence. Narcotics regulations were studied in the French public health code. Status and indications of medicines concerned were found on the French medicine agency website, and the retrospective part of the study was conducted using the French public statute law website. Seventeen medicines were found. Three were psychotropics and fourteen narcotics. The prescription rules could be different for a given substance according to the route of administration or indication. In 2007, half of the narcotic opioids could be prescribed for 28 days, whereas in 1992, most of them could be prescribed for only 7 days. These results show the adaptation of French narcotics regulations, with the development of medicines indicated in acute or chronic pain treatment or opioid maintenance treatment.