[Are antibiotics over-consumed+?].
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Anti-Bacterial Agents↗
Biomedical subjects
D Guillemot
Publications and source records attributed to D Guillemot.
Low dosage and long treatment duration of beta-lactam: risk factors for carriage of penicillin-resistant Streptococcus pneumoniae.
CONTEXT: The spread of drug-resistant Streptococcus pneumoniae in the community is a public health problem in developed and developing nations, but whether antibiotic use is responsible for the increase in drug resistance is not known. OBJECTIVE: To analyze the relationship between penicillin-resistant S pneumoniae (PRSp) pharyngeal carriage and characteristics of beta-lactam use. DESIGN: Observational study of children attending 20 randomly sampled schools. SETTING: The Loiret, in the center of France. PARTICIPANTS: A total of 941 children, 3 to 6 years old. MAIN OUTCOME MEASURE(S): Pharyngeal carriage of S pneumoniae, antibiotic use, and medical events during the preceding 30 days. Pneumococcal penicillin G sodium minimal inhibitory concentrations and serotyping were performed. RESULTS: Medical illnesses and the use of antibiotics were not associated with PRSp carriage. However, oral beta-lactam use was associated with an increased risk of PRSp carriage (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.1-8.3; P=.03). Children treated by low daily doses of an oral beta-lactam (defined as lower than clinical recommendations) had an increased risk of PRSp carriage, as compared with children who did not (OR, 5.9; 95% CI, 2.1-16.7; P=.002). A treatment of long duration (>5 days) with a beta-lactam was associated with an increased risk of PRSp carriage (OR, 3.5; 95% CI, 1.3-9.8; P=.02). CONCLUSIONS: Our results suggest that a low daily dose and a long duration of treatment with an oral beta-lactam contribute to the selective pressure in promoting pharyngeal carriage of PRSp.
Anti-Bacterial Agents↗
Trends in aspirin, paracetamol and non-steroidal anti-inflammatory drug use in children between 1981 and 1992 in France.
OBJECTIVE: Antipyretic/analgesic drugs (AADs) are among the most commonly used drugs in children. Their efficacy and adverse effects have often been debated and new AADs have been introduced over the past few years. The aim of this study was to assess the characteristics of the use of AADs in children in France, and their trends. METHODS: Two surveys on household health care consumption were undertaken in France, in 1981 and in 1992. They included 5060 and 4841 children, respectively. The AADs studied were aspirin, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). RESULTS: The proportion of children exposed to AADs increased significantly between 1981 and 1992 (+28% in 11 years). Among them, the percentage of subjects treated with aspirin decreased (-27%). In contrast, the percentage increased for paracetamol (+ 19%) and for NSAIDs (+179%). Aspirin was the AAD most used in 1981 (57.4%) and it was replaced by paracetamol in 1992 (71.6%). Nasopharyngitis was the main reason for AAD prescription under the age of 11 years; for older children it was influenza-like syndrome, irrespective of the study year. A change in AAD choice occurred in nasopharyngitis, acute bronchitis and influenza-like syndrome irrespective of the age group, and in otitis/sinusitis between 4 and 10 years. In all these cases aspirin prescription decreased, in contrast with paracetamol and NSAIDs. Self-medication of AAD was uncommon (8.3% for aspirin and 10.3% for paracetamol in 1992) and decreased (-29% and -33%). It was used principally for nasopharyngitis, influenza-like syndrome and pain. CONCLUSION: The consumption of AADs in children is high and is increasing. Paracetamol and NSAIDs tend to replace aspirin prescription in children and physicians have played the main role in this change.
Acetaminophen↗
Inappropriateness and variability of antibiotic prescription among French office-based physicians.
OBJECTIVE: To describe oral antibiotic prescription in the community. DESIGN: Audit of anti-infective prescribing in office-based medical practice. SETTING: Center of France, in the Loiret, a 600,000 inhabitant administrative division. MAIN OUTCOME MEASURES: Clinical hypothesis and antimicrobial drugs used as well as daily doses and durations of treatment. RESULTS: Respiratory tract infections with a presumed viral etiology accounted for 36% of prescriptions. In children, a high percentage of antibiotic prescriptions were underdosed as compared to clinical recommendations, particularly in acute otitis media. The variability of the daily dose was high, with coefficients of variation over 40% in acute otitis media or acute tracheobronchitis. Whatever the clinical hypothesis, the duration of treatment was close to 8 days. In acute otitis media, the coefficient of variation was 14%, the lowest for all diagnoses. CONCLUSION: Our investigation identified two main areas for improving antimicrobial drug prescribing: (1) reduction of useless prescriptions in respiratory tract infections with a presumed viral etiology, and (2) increasing the prescribed daily dose of antimicrobials to the recommended levels.
Administration, Oral↗
Trends in antimicrobial drug use in the community--France, 1981-1992.
Trends in the use of antimicrobials in France between 1980-1981 and 1991-1992 were analyzed. Data were obtained from surveys of health and ambulatory care, which were based on national probability samples. In a 3-month period in 1980, 17% of the population of France was treated with an antibiotic, compared with 25% in 1991 (P < .001). The frequency of respiratory tract infections with a presumed viral etiology that were diagnosed and treated with antibiotics increased by 86% for adults and 115% for children in the 11-year period. The proper use of cephalosporins must be encouraged, and vigilance is required in view of the increased improper use of fluoroquinolones, mainly for respiratory tract infections with a presumed viral etiology.
Adult↗
[The working population should continue to rise for a decade].
Future trends in the size and characteristics of the population of working age in France are analyzed using data from official sources. "The future working population is expected to comprise even fewer young people and more women than today. This population should continue to grow and will probably have risen by one and a half million people by 2006, essentially for demographic reasons. The trend should subsequently reverse due to the first post-war generations reaching 60 years old. The working population should therefore start to decrease. Yet the effect of the turnaround should remain modest up to 2015." (SUMMARY IN ENG AND GER AND SPA)
Developed Countries↗
[The working population: a statistical category that is hard to define].
The author examines some of the definitions that have been used to define the working population in France. "The working population resulting from censuses and related statistical sources is based on individuals' spontaneous statements. Its content does not match up exactly with the working population defined by the ILO, which seeks to estimate the labour force available for production. Therefore, certain categories such as ¿discouraged male job-seekers' (160,000 in March 1995), ¿revealed female job-seekers' (housewives who would prefer to work) (130,000) and ¿trainees' (120,000) are considered by the census definition to be in the working population, but are deemed unoccupied by the ILO definition." The author stresses the need to clarify and limit the statistical categories used, so that better forecasts of the future working population can be prepared and the prospects for drawing international comparisons and conducting behavioral analyses can be increased. (SUMMARY IN ENG AND GER AND SPA)
Developed Countries↗
[Medical interns and AIDS: perceptions and attitudes in 3 French regions].
This study has been conducted to clarify certain issues regarding residency training with regard to acquired immunodeficiency syndrome (AIDS). The objective was to evaluate resident physicians' experiences in, and attitudes toward, the care of persons with AIDS in France. The design was a cross sectional study, using a self administered mailed questionnaire to 627 residents in 3 French areas: Ile-de-France, Nord-Pas de Calais and Province-Côte d'Azur, with a follow up of non responders. The subjects of this study were a random sample of residents in the second year of specialty medicine or family medicine residencies (biological residents, surgeons, public health residents and research residents were excluded). The response rate was 56%. More than half of residents indicated that their training was deficient in AIDS ambulatory care and less of 40% felt competent to provide usual and primary care for AIDS patients. The social and psychosocial aspect of care seems to be the greatest difficulties for them. About the half of residents reported at least one needle stock contaminated by a patient's blood. Needle stick injuries from patients known to have HIV infection were reported by 8% of them. About 25% expressed great concern about the professional risk of HIV contamination and 24% indicated it is dangerous to provide care for AIDS patients. It appears that an important component of future education in medical residency programs should emphasize strategies to address social and psychosocial issues in the medical care of AIDS patients and to decrease the risk of needle stick injuries.
Accidents, Occupational↗
[Salmonellosis: therapeutic aspects].
The antibiotic therapy of salmonellosis has changed during the last decade, due to the development of resistance to classical drugs and also to increased knowledge in the conditions of in vitro and in vivo efficacy of new compounds. These new informations led to clinical studies of efficacy and tolerance of fluoroquinolones in the treatment of acute diarrhea or chronic carriage due to Salmonella, or against typhoid fever. These drugs appeared very efficacious and able to significantly shorten the duration of treatment. However, two potential pitfalls have to be kept in mind deserving additional informations: selection of resistant mutants and increased risk of persistent carriage.
Anti-Bacterial Agents↗
The crucial question of standardisation when measuring drug consumption.
The reliability of drug consumption studies will depend on agreement on an international unit of measurement and the provision of accurate descriptions of patterns of use. This measurement unit should permit comparisons between countries and periods of time. Different units have been proposed and published. Consumption may be expressed in terms of pharmaceutical firm turnover, therapeutic costs, weight (total weight or dose equivalent), treatment doses such as defined daily dose and prescribed daily dose, or as number of items or packages sold. The advantages and disadvantages of the different evaluation units used in veterinary medicine are reviewed.
Animals↗
Residents' experiences in, and attitudes toward, the care of persons with AIDS in Canada, France, and the United States.
OBJECTIVE: To evaluate resident physicians' experiences in, and attitudes toward, the care of persons with the acquired immunodeficiency syndrome (AIDS) in Canada, France, and the United States. DESIGN: Cross-sectional survey, using a self-administered, mailed questionnaire to residents in 10 American states, three French regions, and all 10 Canadian provinces, with follow-up surveys of nonresponders in France and the United States. SUBJECTS: Systematic samples of residents in the last year of internal medicine or family medicine residencies prior to subspecialization or entry into medical practice. RESULTS: While the majority of residents had provided inpatient and outpatient care to persons with AIDS, most believed that their training in ambulatory care of persons with AIDS had been deficient. The rate of blood-contaminated needle-sticks from human immunodeficiency virus-infected patients ranged from 4% for internal medicine residents in Canada to 14% in the United States (P less than .05). The majority recognized an ethical obligation to treat AIDS, but 4% in France, 14% in Canada, and 23% in the United States indicated that they would not care for persons with AIDS if they had a choice (P less than .001). A substantial minority of US physicians reported that a patient of theirs had been refused care by a medical specialist (19%) or a surgeon (39%), but less than 10% of French physicians reported such refusals (P less than .001). CONCLUSION: Concerns about caring for AIDS patients were common and many physicians reported that patients were refused care. While most residents acknowledged an obligation to treat human immunodeficiency virus infection, many did not, and viewpoints varied considerably across the countries studied. The lower level of reluctance to treat AIDS patients in France and Canada makes it clear that the higher rate in the United States is far from optimal and needs to be addressed.
Acquired Immunodeficiency Syndrome↗