Arrêt de la valorisation humanitaire des médicaments non utilisés : enjeux et perspectives

Since the 1970s, drugs unused by French households have been collected for humanitarian aid. In 1993, the Cyclamed^® system was created by pharmacists in order to manage and collect unused drugs. However, experience has shown that in developing countries unused drugs caused more problems than they solved, including: poorly adapted to the needs of the population, poor quality of the collected medicines, interferences with local pharmaceutical policies, misappropriation… As recommended by the World Health Organisation, most of the humanitarian organizations stopped unused drug donations. In France this practice has been forbidden since the 1st of January 2009. Associations that still desire to send unused drugs to developing countries must develop other approaches, such as essential generic medicines or emergency health kits.     

Caractéristiques des infections respiratoires basses chez les sujets âgés

Pneumonia is more frequent among the elderly and is associated with higher rates of hospitalization and death. The diagnosis of pneumonia in the elderly is a clinical challenge because of its non-typical symptoms and because of a poor diagnostic yield of microbiological analysis. Ageing is associated with specific pathogenesis, modifications in lung performance and modifications in oropharyngeal flora. The management relies on empirical therapy, which takes into account the severity of the infectious episode, the presence of additional risk factors, co-morbidities and institutionalization.     

Mise en œuvre de procédures d’hygiène et de contrôles physiques et microbiologiques d’environnement au sein d’une unité de radiopharmacie

Preparation of radiopharmaceuticals for injection involves compliance with the regulations for pharmaceutical drugs and radionuclides. The microbiological quality must be ensured, radiation exposure limited, and radioactive contamination of personnel and the environment prevented. Based on work concerning compliance and in accordance with changes in recent regulations, the facilities of the radiopharmacy department of the Louis Mourier Hospital have been optimized. Physical and microbiological controls of equipment and facilities have been implemented to monitor workstations and their environment with respect to microbiological quality. Three hygiene guidelines have also been implemented: improving hygiene practices, personal clothing, practical training on hygiene and its evaluation.     

Vaccination antigrippe A (H1N1) : analyse rétrospective 2009

The occurrence of the influenza A (H1N1) pandemic was the opportunity to set an appropriate vaccination campaign, effective and well tolerated within the shortest period of time. Thanks to a strong experience in the development of seasonal influenza vaccines and recent experimental knowledge on potential vaccines against H5N1 strain, pharmaceutical companies developed a new vaccine suited for the pandemic A H1N1 California July 2009 strain. This vaccine was produced with and without adjuvant, taking into account safety controls and evolution of scientific knowledge. Nevertheless, this campaign got a poor reception from the general and medical population due to the concomitant spread of the pandemics, an insufficient communication program, organization that was felt as unsuited, too complex and not well understood. Despite that, effectiveness and tolerance of the vaccination campaign have been observed with may be a positive effect on the epidemic.     

Recommandations de bon usage des carbapénèmes

Carbapenems are being increasingly used because of the widespread dissemination of antibiotic resistance among Gram-negative bacilli, especially of extended-spectrum beta-lactamases; this increasing use raises the concern of loss of activity for this antimicrobial class following the emergence of carbapenemases. The current guideline from the Anti-infective drugs Committee of the Assistance publique-Hôpitaux de Paris (AP–HP) group emphasizes the careful and limited use of carbapenems, comparing the respective characteristics of the four available molecules, and specifies their indications in clinical hospital practice, with possible alternatives.     

Ocular toxicity of benzalkonium

In order to meet the requirements of the pharmacopeia, ophthalmic preparations have to be manufactured in conditions that can secure their sterility before use and can prevent the development of micro-organisms after opening of the vial. The addition of an appropriate preservative is a way to meet this requirement. However, in addition to their lack of efficacy in certain conditions, they can be problematic in terms of formulation, stability and interaction with the packagings. Furthermore, their daily and repeated use in chronic pathologies such as glaucoma, dry eye or allergy has revealed their nuisance. Moreover, the recognition of certain parameters such as life quality and therapeutic observance has strengthened the proofs that have already been clinically shown. The review of the experimental and clinical data already published about the toxicity of the preservatives shows that almost every ocular structure is affected to various extents. From the first assumption data to preclinical and clinical proofs, this article highlights the evolution of the understanding process towards the toxic role of preservatives.     

Proposal of a costing method for the provision of sterilization in a public hospital

Introduction

To refine the billing to institutions whose operations of sterilization are outsourced, a sterilization cost approach was developed. The aim of the study is to determine the value of a sterilization unit (one point “S”) evolving according to investments, quantities processed, types of instrumentation or packaging.

Materials and methods

The time of preparation has been selected from all sub-processes of sterilization to determine the value of one point S. The time of preparation of sterilized large and small containers and pouches were raised. The reference time corresponds to one bag (equal to one point S). Simultaneously, the annual operating cost of sterilization was defined and divided into several areas of expenditure: employees, equipments and building depreciation, supplies, and maintenance.

Results

A total of 136 crossing times of containers were measured. Time to prepare a pouch has been estimated at one minute (one S). A small container represents four S and a large container represents 10 S. By dividing the operating cost of sterilization by the total number of points of sterilization over a given period, the cost of one S can be determined.

Discussion/conclusion

This method differs from traditional costing method in sterilizing services, considering each item of expenditure. This point S will be the base for billing of subcontracts to other institutions.     

Medical devices classification: principles and quality management

Medical device market covers a large rank of references and is characterized by a lack of standardization in products naming. Using a specific classification is the first step to ensure a good analysis and a specific follow up of this market. CLADIMED is the classification for medical device used in France and Belgium. It is a five level classification, similar to the Anatomical Therapeutical Chemical classification (ATC) for drugs (WHO). CLADIMED association, gathering users and suppliers, manage this classification. A scientific committee is in charge to guarantee quality and respect of the classification principles.     

Handiness and acceptability of the new Abak bottle in chronically treated patients. A cross-sectional, retrospective and multicentre study

Background

Difficulty of use of eyedrops is a factor associated with poor patient compliance that reduces treatment efficacy. The aim of this study was to evaluate the handiness and global acceptability of the new Abak^® timolol bottle (multidose preservative-free eyedrops) in comparison with that of other administration systems (classical multidose eyedrops or single-doses) in patients treated for glaucoma or ocular hypertension.

Methods

Cross-sectional, retrospective and multicentre study involving 41 ophthalmologists in France. Selected patients were those who had been treated with the new Abak^® bottle since at least two months, as a replacement for other beta-blocker eyedrops. Handiness and acceptability of the new Abak^® bottle in comparison with other delivery systems were evaluated using a questionnaire filled by the investigator.

Results

Almost all the patients were unanimous regarding the handiness of the new Abak^® bottle: easy to open for 96.5% of them, easy to handle for 96.0%, and easy to get drops for 91.1%. For all these criteria and in a general manner, patients preferred the new Abak^® bottle in comparison with the previous eyedrop container. These results were confirmed in the oldest patients.

Conclusion

The new Abak^® bottle had a greater acceptability compared to preserved multidose eyedrops or to single-doses. Its handiness and the absence of preservative which may improve local tolerance are in favor of a greater compliance in chronically treated patients.     

Interactions entre les cyclodextrines et les triglycérides : de la stabilisation des émulsions à l’obtention d’un nouveau système galénique appelé « billes »

Natural cyclodextrins are cyclic oligosaccharides which can be modified to obtain more water soluble or insoluble derivatives. The main interest of cyclodextrins results from their ability to form an inclusion complex with hydrophobic molecules. Inclusion constitutes a true molecular encapsulation. This property is employed in pharmaceutical industry to facilitate the formulation of poorly water soluble and/or fragile drugs. A more recent application of cyclodextrins consists in their use in the preparation of dispersed systems such as micro- and nanoparticles or even liposomes. When incorporated in dispersed systems, cyclodextrin can enhance drug solubility, drug stability and drug loading. Interestingly, cyclodextrins themselves can also be employed to form or stabilise dispersed systems (material or emulsifying agent). For example, the interactions between cyclodextrins with components of the vegetable oils (more especially with triglycerides) allow to stabilise simple or multiple emulsions but also to form particles called “beads”. Very rich in oil, this novel lipid carrier presents an important potential for the encapsulation of highly lipophilic compounds and their delivery by topical and oral routes. These two applications are more particularly developed in the present paper.     

L’histoire des Annales pharmaceutiques françaises. 1809–2009

The Annales pharmaceutiques françaises is 200 years old. Initially, in 1809, the Bulletin de pharmacie was the organ of the Société de pharmacie de Paris. The journal was one of the dynamic events stimulated by the law of Germinal in year XI of the French revolution (1803). Its readership increased tremendously, rapidly making it the first regular journal in the pharmaceutical world. In 1984 it became the Journal de pharmacie et chimie published for a century. It was in 1943 that the journal took on its current name of the Annales pharmaceutiques françaises. The journal is now the official organ of the French National Academy of Pharmacy. The six annual issues are supplemented by an internet diffusion allowing readers access in all French-speaking countries.     

Pourquoi des recommandations de vaccination généralisée contre le méningocoque C en France ?

In 2009, the French authorities have recommended the immunization against meningococcus C (MenC) of all infants between 1 and 2 years of age with a catch-up in children, adolescents and adults up to 24 years of age. The rationale of this decision relies on four major considerations: (1) after a peak in 2002, the incidence of invasive MenC disease remains stable at 0.3/100,000 in France and is henceforth, among the highest in Europe; (2) the recent evolution of circulating MenC strains shows the implantation of an hypervirulent strain C:2a:P1.7,1 belonging to the clonal complex E15/ST11; (3) meningococcal C conjugate vaccines are available and have demonstrated a good immunogenicity and tolerance in infants, children and adults; (4) some European countries have successfully experienced the implementation of universal MenC immunization targeting infants with an extensive catch-up program covering children and young adults. The choice of the strategy have been oriented by the results of a medico-economical study with modelisation and targets the infant between 1 and 2 years of age with transient extension to children, adolescents and adults up to 24 years of age. The success of such strategy is tightly linked to the ability to obtain rapidly high vaccination coverage levels in the whole target.