Objectives. - Main objective: the authors wanted to evaluate the impact of recommendations for curative antibiotic therapy on the rate of prescriptions adapted to the indication, in the Lagny-Marne-la-Vallee Hospital. Secondary objectives: they also wanted to evaluate: the impact of recommendations for curative antibiotic therapy on the rate of prescriptions adapted to all of the defined suitability criteria, on bacterial ecology, and on the cost of antibiotics; and the rate of nosocomial infections.Materials et methods. - Detailed prescriptions were compared over 3 month period, before and one year after distribution of recommendations for curative antibiotic therapy. The prescriptions were made under the same conditions, prospectively over 3 months, and analyzed using each suitable criterion. The criteria used were those designed for the study which was made before recommendations were edited.Results. - A significant increase was noted in the number of prescriptions adapted to all of the suitability criteria, but there was no impact on the rate of suitability for the indication. There was a marked reduction in unsuitability due to economic reasons, and an increase in the rate of unsuitable prescriptions due to a non-prescription of association of antibiotics. (C) 2003 Editions scientifiques et medicales Elsevier SAS. All rights reserved.

OBJECTIVE AND METHODS:Infections due to microsporidia are increasingly recognized as opportunistic infections in patients with AIDS. We describe here a case of disseminated infection due to Encephalitozoon cuniculi and review the literature on this microsporidial infection.RESULTS:All 12 patients reported in the literature had AIDS and nine presented with disseminated infection involving the kidneys, sinuses, lungs, brain and conjunctiva. Asymptomatic infection was seen in three patients. Microsporidia were detected by light microscopy examination of urine samples in all the cases. Species identification was performed by various genotypic methods or transmission electron microscopy. Eight of 12 patients who received albendazole therapy experienced clinical improvement with documented clearance of spores in five of these eight patients. Two patients relapsed.CONCLUSIONS:E. cuniculi infection should be considered in severely immunocompromised HIV-infected patients with multi-organ involvement and fever, especially when renal failure is present. Microsporidial spores are usually seen in urine samples and in the involved organ. Albendazole therapy seems to be effective.

Objectives - The authors carried out an exhaustive prospective study of the detailed antibiotic treatment taken from pre-printed prescriptions, written between February 3 and April 30 1997, so as to assess their relevance.Material and methods - Aii the hospital departments participated except the Psychiatry Department, the Day Care Center, the Trauma and Emergency Department, and the Outpatients Clinic. The prescriptions were analyzed by an infectious diseases specialist and a pharmacist, according to pre-established criteria decided by consensus.Results - Prescriptions (656) were collected from 498 patients. Forty-seven percent of the prescriptions were adapted to the indication described. The percentage increased to 68% if the criterion for treatment insuitability 'treatment too short' was excluded; this criterion was often confused with the anticipated duration of hospitalization. The second most frequently encountered criterion of insuitability was the availability of cheaper alternatives. In 12% of prescriptions, the antibiotic prescribed was not adapted to the indication. Publishing the results of this study in the hospital allows prescribing physicians to a better awareness of correct antibiotic use. (C) 1999 Elsevier, Paris.