[Prescribing practices of fluoroquinolones in Tunisia]. / Evaluation des pratiques de prescription des fluoroquinolones en médecine de ville en Tunisie.

The aim of the study was to assess the prescribing practices of fluoroquinolones (FQ) among general practionners in the town of Sousse (central-eastern Tunisia). A transversal study was made between the first and the 23rd April, 2009, among general practionners working in Sousse. For each prescription, informations about patients, indications and modalities of treatment were collected on a questionnaire. These prescriptions were compared to Tunisian and/or French guidelines for antibiotics use. One hundred and eighty eight FQ prescriptions were analyzed. The mean age of patients was 50 years. FQ were more often used alone (83%) and in first line intention (84%). The molecules used were essentially ciprofloxacin (44.7%), levofloxacin (35.6%) and ofloxacin (18.6%). The indications were mainly bronchopulmonary infections (34%) and urinary tract infection (32%). These choices were in accordance with guidelines in 41% of the prescriptions. The dosage was adapted, but the duration of treatment was often excessive. Further efforts are needed, to optimize the good use of FQ in order to reduce or stabilize the rate of bacterial resistance.

Demodicosis revealing an HIV infection.

We report an observation of facial and upper limb demodicosis, revealing a human immunodeficiency virus infection. After an initial improvement with metronidazole, worsening of skin lesions related to immune reconstitution inflammatory syndrome was observed, requiring the use of steroids.

Alternaria alternata infection causing rhinosinusitis and orbital involvement in an immunocompetent patient.

Invasive fungal rhinosinusitis is a rare infection that occurs primarily in immunocompromised patients. The fungal pathogen Alternaria alternata is rarely associated with rhinosinusitis. We report a case of A. alternata rhinosinusitis in an immunocompetent patient.

Complications following intravesical bacillus Calmette-Guerin treatment for bladder cancer: a case series of 22 patients.

BACKGROUND: Intravesical bacillus Calmette-Guerin (BCG) therapy is an effective and widely used treatment for superficial bladder carcinoma. Local complications are frequent whereas systemic complications are rare but can be serious, and their management is not well known. METHODS: We describe retrospectively the records of 22 patients treated in 3 infectious disease departments, for complications related to intravesical BCG therapy as treatment of bladder cancer. RESULTS: All the patients were male, with a median age of 68 years (range 56-88). Complications occurred after a median of 5 instillations (range 1-11) and were observed within 24 h following BCG instillation for 14 patients. Common symptoms were fever (n = 20), impaired general condition (n = 14), and shortness of breath (n = 7). Six patients had a systemic septic reaction leading to transfer into the intensive care unit for five of them. Lung infiltration was the most frequent presentation (n = 11). Mycobacterium bovis was isolated from only two patients, but histology showed the presence of a granuloma in nine patients. Antimycobacterial treatment was initialized in 17 patients; the outcome was favorable in 16 patients, with a median length of symptoms resolution of 22.5 days (range 5-425 days). Eleven patients received corticosteroids in addition to specific treatment and had a more rapid improvement. One patient died with disseminated BCGitis proved by biopsy. CONCLUSIONS: Complications following intravesical BCG therapy are rare but can be severe and fatal. Histology seems to be the method that contributes most in confirmation of the diagnosis. Antimycobacterial therapy is effective, and probably more efficient when combined with corticosteroids, but the regimen and duration of the treatment are not standardized.