Comparison of in-vivo antibacterial activity of two skin disinfection procedures for insertion of peripheral catheters: povidone iodine versus chlorhexidine.

Skin disinfection is a key step in the prevention of nosocomial infections especially prior to invasive procedures such as the insertion of peripheral catheters. Alcohol-based antiseptics improve bactericidal activity and decrease the time needed for skin disinfection in emergencies. A randomized study was performed in two groups of 22 volunteers to compare the in vivo bactericidal effect of two rapid disinfection procedures using povidone iodine (PVP-I) in scrub formulation followed by alcoholic PVP-I, or chlorhexidine in scrub formulation followed by alcoholic chlorhexidine. Bacteria were recovered using the cylinder scrub method. Comparison of reductions in the aerobic and anaerobic flora from baseline levels to each of the three sampling times (30 sec, 3 min, 2 h) showed no significant difference between the two procedures Log(10)reduction after 30 seconds was around 1.5 for the aerobic flora and 1.1 for the anaerobic flora. After 3 minutes the corresponding values were 2.1 and 1.8, and after 2 hours 2.0 and 1.3. The products were well tolerated in both groups. The two procedures had comparable rapid bactericidal activity in vivo.

[Acceptability of local treatment of allergic rhinitis with a combination of a corticoid (beclomethasone) and an antihistaminic (azelastine)]. / Acceptabilité d'un traitement local de la rhinite allergique associant un cortidoïde (béclométasone) et un antihistaminique (azélastine).

A prospective multicentre study involving 219 patients with seasonal or aperiodic rhinitis was performed to assess the acceptability of a local treatment combining antihistamine (azelastine) and corticoid (beclomethasone) drugs. The drugs were administered either together (morning and evening, with a 5-minute interval) or separately (azelastine in the morning and evening, and beclomethasone later during the morning and in the afternoon) for 15 days. Treatment acceptability was measured by a nine-fold questionnaire (7-point scale, mean score per question). Patient participation, protocol and therapy compliance, and treatment efficacy and tolerance were also studied. The acceptability of the association was satisfactory (mean score for general facility of treatment: 4.7/6) and did not differ between administration schedules. Patients found treatment easy, and were not bothered by the bulk of the bottles or the risk of mixing them up. This acceptability was confirmed by the low percentage (4%) of patients refusing to be included in the study (refusing any treatment by nasal spray). The general acceptability was confirmed by the results for therapy compliance, general efficacy and tolerance: 94.9% of the patients took more than 75% of the administrations prescribed, 77.6% of the patients and 85.2% of the practitioners judged treatment efficacy as good or excellent, and 84.6% of the patients and 91.4% of the practitioners judged tolerance as good or excellent. Moreover, most of the adverse events consisted of minor signs of local intolerance, and were identical to those observed when the two treatments were administered alone.

[Medico-economic aspects of the management of perennial allergic rhinitis in general medicine]. / Aspects médico-économiques de la prise encharge des rhinites allergiques perannuelles en médecine générale.

A cross sectorial epidemiologic study was conducted in daily medical practice on the cost of perannual rhinitis. This study on 2033 patients shows per consultation the following costs. Medical fees: 130 +/- 45 francs, pharmaceutical expenses: 141 +/- 59 francs, biological and imaging: 109 +/- 174 francs. The indirect costs link to the absent days are evaluated at 776 francs. This rhinitis costs 1156 francs or 380 francs according the fact that the patient stops working or not. The extrapolation of these results to the french population shows 3.42 billions francs for the direct costs and 6 billions for the indirect costs. By comparison to this total amount, medical and pharmaceutical expenses represent only 11.7% and 12.7%.

[Observational study of the initial prescription of level 3 analgesics in cancer patients.]. / Enquête observationnelle sur la primoprescription d'antalgiques de palier 3 chez les patients cancéreux.

To evaluate pain management in cancer patients, a study was conducted examining the treatment circumstances and modalities of initial prescription level 3 analgesics used by 122 French cancer specialists. The rationale for moving to level 3, the implementation and the follow-up were evaluated in 1,038 patients. The reasons underlying the initial prescription were in line with recommendations for clinical practice (WHO, SOR) and the professionals generally preferred molecules with which they were already familiar. Though pain intensity was reduced in 67% of patients, treatment follow-up could have been improved in a number of cases. In particular, titration was not systematically performed, and the interruption of the prescribed treatment (owing to inefficacy or negative side-effects) was not sufficiently timely. The awareness-raising campaigns performed over the past few years should be continued, underlining the importance of early follow-up, notably during the titration phase of level 3 analgesic initiation.