Évaluation de l’observance aux médicaments anti-infectieux chez les patients pédiatriques hospitalisés au CHU de Nîmes après retour à domicile

L’observance médicamenteuse joue un rôle important dans l’émergence des résistantes bactériennes. Cette problématique est d’autant plus importante en population pédiatrique pour laquelle le panel thérapeutique est réduit. Ainsi, les objectifs de cette étude étaient de déterminer le taux d’observance médicamenteuse globale aux anti-infectieux en population pédiatrique prescrits en sortie d’hospitalisation et d’identifier secondairement les facteurs de risque de non-observance. Cette étude observationnelle a été menée au CHU de Nîmes sur 3 mois. Les patients inclus étaient âgés de moins de 16 ans, admis en hospitalisation complète de pédiatrie et sortant avec une prescription d’au moins un anti-infectieux prescrit pour une infection aigüe. L’observance médicamenteuse et la connaissance aux antibiotiques ont été évaluées à partir de données collectées par entretien téléphonique. 75 patients ont été inclus et les données de 63 patients ont pu être exploitées dans l’évaluation et l’analyse de l’observance médicamenteuse. L’âge médian était de 1,4 ans [0,7 ; 3,3]. Le taux de patients observants aux anti-infectieux était de 34.9 %. L’amoxicilline (29.3%), l’amoxicilline/acide clavulanique (25.3%), le cotrimoxazole (18.7%) et le Céfixime (12.0%) étaient les antibiotiques les plus prescrits. Le résultat du test de connaissance s’est avéré être significativement associé à une mauvaise observance médicamenteuse. En conclusion, notre étude révèle que 65.1% des patients sont inobservants aux anti-infectieux pris à domicile. Nos résultats confirment la nécessité de mettre en œuvre des mesures préventives à la sortie par le biais d’informations sur l’ensemble des modalités de prise

Correction to: Assessment of anti-infective medication adherence in pediatric outpatients

International audienceNo abstract availabl

Assessment of anti-infective medication adherence in pediatric outpatients

International audienc

Neuroendocrine regulation of GnRH release in induced ovulators.

GnRH is the key neuropeptide controlling reproductive function in all vertebrate species. Two different neuroendocrine mechanisms have evolved among female mammals to regulate the mediobasal hypothalamic (MBH) release of GnRH leading to the preovulatory secretion of LH by the anterior pituitary gland. In females of spontaneously ovulating species, including rats, mice, guinea pigs, sheep, monkeys, and women, ovarian steroids secreted by maturing ovarian follicles induce a pulsatile pattern of GnRH release in the median eminence that, in turn, stimulates a preovulatory LH surge. In females of induced ovulating species, including rabbits, ferrets, cats, and camels, the preovulatory release of GnRH, and the resultant preovulatory LH surge, is induced by the receipt of genital somatosensory stimuli during mating. Induced ovulators generally do not show "spontaneous" steroid-induced LH surges during their reproductive cycles, suggesting that the positive feedback actions of steroid hormones on GnRH release are reduced or absent in these species. By contrast, mating-induced preovulatory surges occasionally occur in some spontaneously ovulating species. Most research in the field of GnRH neurobiology has been performed using spontaneous ovulators including rat, guinea pig, sheep, and rhesus monkey. This review summarizes the literature concerning the neuroendocrine mechanisms controlling GnRH biosynthesis and release in females of several induced ovulating species, and whenever possible it contrasts the results with those obtained for spontaneously ovulating species. It also considers the adaptive, evolutionary benefits and disadvantages of each type of ovulatory control mechanism. In females of induced ovulating species estradiol acts in the brain to induce aspects of proceptive and receptive sexual behavior. The primary mechanism involved in the preovulatory release of GnRH among induced ovulators involves the activation of midbrain and brainstem noradrenergic neurons in response to genital-somatosensory signals generated by receipt of an intromission from a male during mating. These noradrenergic neurons project to the MBH and, when activated, promote the release of GnRH from nerve terminals in the median eminence. In contrast to spontaneous ovulators, there is little evidence that endogenous opioid peptides normally inhibit MBH GnRH release among induced ovulators. Instead, the neural signals that induce a preovulatory LH surge in these species seem to be primarily excitatory. A complete understanding of the neuroendocrine control of ovulation will only be achieved in the future by comparative studies of several animal model systems in which mating-induced as well as spontaneous, hormonally stimulated activation of GnRH neurons drives the preovulatory LH surge