Removal of bacterial growth inhibition of anticancer drugs by using complexation materials

In the context of batch production of cytotoxic drugs in hospital pharmacies with the need of sterility testing, the objective was to validate the use of Rapid Microbiological Method (RMM), and to develop adequate neutralization method in case of inhibition of bacterial growth. The potential microbiological growth inhibitory effect of three anticancer drugs (5 fluorouracil, irinotecan and oxaliplatin) selected for batch production was assessed on BacT/ALERT® system. Among cytotoxic drugs, only 5FU exhibited inhibitory effect on microbiological growth using rapid microbiological method. To counteract this effect our purpose was to use neutralizing agents complexing the drug i. e. activated carbon or ion exchange resins. The microbiological bactericidal concentration of 5FU was very low (1.10–4 mg/mL) indicating the absolute need to neutralize the whole drug before sterility test. The complexation was validated by High Performance Liquid Chromatography control of the residual 5FU concentration in solution after the use of neutralizing agents. Only activated carbon was able to fully capture 5FU when previously diluted at 5 mg/mL. Conversely, the resins, in the condition of the study, were not able to fully capture 5FU whatever the dilution. The microbiological growth on BacT/ALERT® system after active carbon treatment was successfully confirmed with Staphylococcus aureus. Based on this validation results a method was then developed to routinely be able to perform sterility test of the batches produced and was confirmed on five microbiological species (i. e. S. aureus, Pseudomonas aeruginosa, Bacillus subtilis, Candida albicans, Aspergillus brasiliensis). Our work gives a new insight for considering sterility testing by rapid microbiological method even for drugs exhibiting inhibitory effect on microbiological growth

Conciliation médicamenteuse et lien ville-hôpital

À l’hôpital, les erreurs médicamenteuses surviennent plus particulièrement aux points de transition des services de soins : lors de l’admission du patient, de son transfert vers un autre service ou de sa sortie en vue du retour à son domicile. La conciliation médicamenteuse de sortie établit un lien entre l’hôpital et la ville. Ce lien ville-hôpital permet de répondre aux attentes des pharmaciens d’officine et des médecins traitants et les intègre au mieux à la prise en charge des patients.In hospital, medication errors occur most frequently at the points of transition of care: at the time of the patient's admission, their transfer to another ward or their discharge. The discharge medication reconciliation establishes a link between the hospital and the community. This link ensures that community pharmacists’ and general practitioners’ expectations are met and integrated into the patient's overall care

Automation of Aseptic Sterile Preparation: Risk Analysis and Productivity Comparison with Manual Process

Two automation methods for aseptic preparation in hospital pharmacy, robot and peristaltic pump, were compared to manual process both for risk analysis using Failure Modes Effects and Criticality Analysis (FMECA) method and for productivity using time analysis grids built for each process

La greffe pulmonaire et ses traitements.

La transplantation pulmonaire offre aux malades atteints d’insuffisance respiratoire terminale l’espoir d’une durée de vie augmentée, mais aussi d’une meilleure qualité de vie et d’une autonomie plus grande. Après la greffe, les patients doivent bénéficier d’une prise en charge rigoureuse et accepter de prendre un traitement à vie. En cela, le suivi après la transplantation constitue une véritable “nouvelle maladie chronique” à laquelle ils devront s’adapter.A lung transplant offers patients with terminal respiratory failure the hope of a longer life expectancy, as well as a better quality of life and greater autonomy. After the transplant, patients must receive rigorous care and accept that they will have to take medication for the rest of their lives. In this respect, the post-transplant follow-up constitutes a ‘new chronic condition’ to which they must adapt

Place du pharmacien dans l’éducation thérapeutique.

L’éducation thérapeutique du patient (ETP) est un processus centré sur la personne et intégré à son parcours de soins. L’objectif de l’ETP est de rendre le patient autonome et acteur de sa prise en charge, grâce à l’acquisition et le maintien des compétences dont il a besoin pour gérer au mieux sa maladie chronique.Therapeutic patient education (TPE) is a process focused on the patient and integrated into their care pathway. The objective of TPE is to help the patient become autonomous and a player in their own treatment, by acquiring and maintaining the skills which they need to be able to manage their chronic disease

Implementation of infliximab standardized doses after pharmacokinetic modelization in a cohort of patients with Crohn’s disease

International audienceBACKGROUND:According to infliximab (IFX) license in Crohn's disease (CD), infusion doses are based on patient's body-weight. Dose banding providing standardized doses (SD) has been implemented in parenteral chemotherapy in order to optimize aseptic unit capacity and reduce drug expenditure, duration of hospital stay and costs without decreasing efficacy.MATERIAL AND METHOD:The first part was a single-center retrospective analysis of consecutive CD patients receiving IFX maintenance therapy to determine standardized doses covering more than 50% of infusions. The second part was a prospective cohort study assessing the impact of SD compared to body-weight doses (BWD) on admission duration and costs.RESULTS:Six IFX SD covering more than 90% of infusion doses were implemented for dose banding. According to the Monte-Carlo simulation, there was no significant difference between IFX SD and BWD maintenance regimens. When assessed prospectively in 116 patients (75 patients treated with SD and 41 with BWD) corresponding to 128 infusions, hospitalization duration was shortened by 70 min per patient (p < 0.001).CONCLUSION:According to a pharmacokinetic model, IFX SD has a pharmacokinetic profile close to BWD and is associated with reduced length of hospitalization in a cohort of patients with CD. IFX SD implementation could optimize infusion units functioning and, save time and costs without decreasing efficacy