Physicochemical stability of norepinephrine bitartrate in polypropylene syringes at high concentrations for intensive care units

International audienceOBJECTIVES:Norepinephrine is usually used in emergency situations such as in intensive care units (ICUs) for the restoration of blood pressure. The objective was to study the stability of highly-concentrated solutions of norepinephrine at 0.50mg/mL and 1.16mg/mL, diluted in glucose 5% (G5%) in polypropylene syringes, protected or not from light, up to 48h.MATERIALS AND METHODS:Chemical stability was analysed by high-performance liquid chromatography coupled to photodiode array detection at each time of the analysis. The method was validated according to the International Conference on Harmonisation Q2(R1). Physical stability was evaluated by visual and subvisual inspection. Three syringes for each condition were prepared. At each time of the analysis, three samples were analysed for each syringe. pH values were evaluated at each moment of the analysis.RESULTS:Solutions of norepinephrine at 0.50 and 1.16mg/mL, diluted in G5%, with or without protection from light, retained more than 95.0% of the initial concentration after a 48-hour storage at 20-25°C. No visual and subvisual modification occured during the stability study. No degradation product appearing during the stressed degradation was observed during the study but an additional peak with a relative retention at 0.66 was observed and constant. This peak was identified as 5-hydroxymethylfurfural, a degradation product of glucose.CONCLUSION:Norepinephrine diluted in G5% at 0.50mg/mL and 1.16mg/mL was physically and chemically stable over a period of 48hours at room temperature. These stability data of highly concentrated solutions provide additional knowledge to assist intensive care services in daily practice

Mise en place d’un parcours d’intégration et de formation pour les agents de stérilisation

International audienc

First international database of research teams in stability and compatibility of medications: An additional function in the Stabilis® database

International audienc

Reliability of self-reported recent antibiotic use among the general population: a cross-sectional study

International audienc

Le bon usage des antifongiques à l’échelle d’une région française

International audienceBackgroundThe increased use of new costly antifungal agents has led to a considerable increase in pharmaceutical expenditure. In December 2011, the Lorraine Regional Health Agency commissioned the Antibiolor network to evaluate costly antifungal agent stewardship using as reference regional, French, and international recommendations.MethodsWe performed a regional retrospective multicenter study. The criteria for evaluation were the appropriateness of the indication for treatment, the choice of the agent or of a combination, compliance with dose and treatment duration, and the absence of any alternative.ResultsOne hundred and fourteen prescriptions were analyzed, in 7 intensive care units, 4 hematology units, and 1 infectious diseases unit. The indication for costly antifungal treatment was appropriate in 110 cases (96.5%), the choice of the antifungal agent in 102 cases (93%), the dose in 98 cases (89%), treatment duration in 102 cases (93%), and an alternative antifungal treatment was possible in 10 cases (9%). Eighty-two prescriptions (74.5%) complied with the marketing authorization, 19 (17%) were related to a protocol for temporary use, and 9 (8%) were considered as inappropriate.ConclusionOur results show a high rate of appropriate prescriptions. The easily accessible and regularly updated local recommendations probably resulted in the standardization and optimization of costly antifungal agent prescriptions.ContexteLes nouveaux antifongiques sont des molécules onéreuses et l’augmentation de leur consommation est à l’origine d’une forte augmentation des dépenses pharmaceutiques. En décembre 2011, l’Agence régionale de santé de Lorraine a mandaté le réseau Antibiolor pour la réalisation d’un audit sur le bon usage des antifongiques dans les établissements de santé prescripteurs de la région, en prenant comme références le référentiel local et les recommandations françaises et internationales.MéthodeÉtude rétrospective multicentrique régionale. Les critères d’évaluation étaient la pertinence de l’indication du traitement, du choix de la molécule ou de l’association, le respect de la posologie et de la durée de traitement, et l’absence d’alternative.RésultatsCent quatorze prescriptions ont été analysées, dans 7 services de réanimation, 4 d’hématologie et 1 de maladies infectieuses. Le traitement antifongique était indiqué dans 110 cas sur 114 (96,5 %). Sur les 110 prescriptions indiquées, le choix de la molécule antifongique était pertinent dans 102 cas (93 %), la posologie dans 98 cas (89 %), la durée du traitement dans 102 cas (93 %) et un traitement antifongique alternatif était possible dans 10 cas (9 %). Quatre-vingt-deux prescriptions (74,5 %) étaient conformes au libellé de l’autorisation de mise sur le marché, 19 (17 %) étaient en lien avec un protocole temporaire d’utilisation et 9 (8 %) étaient considérées comme situations non acceptables.DiscussionNotre évaluation montre une proportion élevée de prescriptions conformes. L’existence d’un référentiel régional actualisé et accessible a probablement permis d’uniformiser et d’optimiser les prescriptions d’antifongiques coûteux