Compliance with the current recommendations for prescribing antibiotics for paediatric community-acquired pneumonia is improving: data from a prospective study in a French network.

Background: Lower respiratory tract infection is a common cause of consultation and antibiotic prescription in paediatric practice. The misuse of antibiotics is a major cause of the emergence of multidrug-resistant bacteria. The aim of this study was to evaluate the frequency, changes over time, and determinants of non-compliance with antibiotic prescription recommendations for children admitted in paediatric emergency department (PED) with community-acquired pneumonia (CAP).

Nefopam enantiomers: preclinical pharmacology/toxicology and pharmacokinetic characteristics in healthy subjects after intravenous administration.

Nefopam (NEF) is a potent analgesic compound administered as a racemic mixture. Previous in vitro and in vivo studies with nefopam enantiomers have shown that (+)nefopam [(+)NEF] is substantially more potent than (-)nefopam [(-)NEF]. Differences between enantiomers have also been suggested in metabolic studies in vitro.

Mechanisms of mutagenesis in mammalian cells. Application to human thyroid tumours.

Mutations are defined as stable and irreversible modifications of the normal genetic message due to small changes in the number or type of bases, or to large modifications of the genome such as deletions, insertions or chromosome rearrangements. These lesions are due to either polymerase errors during normal DNA replication or unrepaired DNA lesions, which will give rise to mutations through a mutagenic pathway. The molecular process leading to mutagenesis depends largely on the type of DNA lesions.

Influence of stiripentol on cytochrome P450-mediated metabolic pathways in humans: in vitro and in vivo comparison and calculation of in vivo inhibition constants.

Objective: The spectrum of cytochrome P450 inhibition of stiripentol, a new anticonvulsant, was characterized in vitro and in vivo.

Methods: Stiripentol was incubated in vitro with (R)-warfarin, coumarin, (S)-warfarin, (S)-mephenytoin, bufuralol, p-nitrophenol, and carbamazepine as probes for CYPs 1A2, 2A6, 2C9, 2C19, 2D6, 2E1, and 3A4, respectively. Caffeine demethylation and the 6 beta-hydroxycortisol/cortisol ratio were monitored in vivo before and after 14 days of treatment with stiripentol as measures of CYP1A2 and CYP3A4 activity, and dextromethorphan O- and N-demethylation were used to measure CYP2D6 and CYP3A4 activity, respectively.

Pharmacokinetics and metabolism of the novel anticonvulsant agent N-(2,6-dimethylphenyl)-5-methyl-3-isoxazolecarboxamide (D2624) in rats and humans.

N-(2,6-dimethylphenyl)-5-methyl-3-isoxazolecarboxamide (D2624) belongs to a new series of experimental anticonvulsants related to lidocaine. This study was undertaken to understand the pharmacokinetics and metabolism of D2624 in rats and humans, with emphasis on the possible formation of 2,6-dimethylaniline (2,6-DMA). After oral administration of stable isotope-labeled parent drug to rats and GC/MS analysis of plasma samples, two metabolites were identified: D3017, which is the primary alcohol, and 2,6-DMA, formed by amide bond hydrolysis of either D2624 or D3017.

Disposition and metabolism of 2,6-dimethylbenzamide N-(5-methyl-3-isoxazolyl) (D2916) in male and female rats.

Disposition and metabolism of the new anticonvulsant 2,6-dimethylbenzamide N-(5-methyl-3-isoxazolyl) (D2916) was studied in male and female rats after oral administration of 14C-labeled material. D2916 was well absorbed in both sexes and distributed to all tissues, with maximal drug concentrations found in elimination and metabolization organs, as well as in fatty tissues. Striking differences in pharmacokinetic parameters of total radioactivity were observed between males and females; females had higher brain concentrations and longer blood and tissue half-lives.

Metabolic chiral inversion of stiripentol in the rat. II. Influence of route of administration.

As described in the accompanying study, it was found that when the S enantiomer of stiripentol [(S)-STP] was given orally to rats, blood specimens contained only (S)-STP, whereas following administration of an equivalent dose of (R)-STP, both R and S forms of the drug were detected in the systemic circulation. In the present study, we investigated the influence of route of administration on this apparently unidirectional chiral inversion of (R)-STP in the rat. When (R)-STP was given either intravenously (60 mg kg-1) or intraperitoneally (300 mg kg-1), the inversion phenomenon was not observed, indicating that the process must take place presystemically.

Metabolic chiral inversion of stiripentol in the rat. I. Mechanistic studies.

To study enantioselective aspects of the disposition of stiripentol (STP), a chiral allylic alcohol undergoing development as an antiepileptic drug, a stereoselective synthesis was developed and the configuration of the two enantiomers determined to be (R)-(+) and (S)-(-). Following a single oral dose (300 mg kg-1) of the individual enantiomers to adult male Sprague-Dawley rats, it was found that (R)-STP was transformed extensively to its antipode, whereas little inversion was detected when (S)-STP was administered. Studies on the mechanism of this apparently unidirectional chiral inversion revealed that the phenomenon was dependent on the presence of the side-chain C==C double bond, because the enantiomers of the corresponding saturated alcohol (D2602) did not interconvert in vivo.

Disposition of stiripentol in the pregnant and non-pregnant female rat.

1. The disposition of stiripentol labelled with 14C and 3H on two positions has been studied in the pregnant and non-pregnant female rat after p.o.

Comparative anticonvulsant potency and pharmacokinetics of (+)-and (-)-enantiomers of stiripentol.

The anticonvulsant potency and pharmacokinetics of the enantiomers of stiripentol were compared using the intravenous pentylenetetrazol infusion seizure model in the rat. Enantioselectivity was observed with respect to both the anticonvulsant activity and elimination kinetics of this compound. (+)-Stiripentol was 2.

In vitro and in vivo investigations of dihydropyridine-based chemical delivery systems for anticonvulsants.

A dihydropyridine-based chemical delivery system (CDS), intended to improve drug delivery to the brain, was investigated with a series of analogues of the anticonvulsant striripentol. In vitro experiments demonstrated that the rates of hydrolysis of the corresponding pyridinium conjugates were influenced markedly by small changes in the structure of the drug moiety to be released. Thus, allylic esters were hydrolyzed rapidly to drug in all aqueous media, while the analogous saturated esters and an allylic amide derivative were almost totally stable.

Polymorphism of carbamazepine: solid-state studies on carbamazepine dihydrate.

Carbamazepine dihydrate (CBZ.2H2O) crystallizes in the orthorhombic system, space group Cmca or C2ca. The unit-cell constants are: a = 19.

The metabolic fate of stiripentol in the rat. Studies on cytochrome P-450-mediated methylenedioxy ring cleavage and side chain isomerism.

Following a single oral dose (200 mg Kg (-1) of stiripentol t (1) o adult male Sprague-Dawley rats, a total of 15 metabolites (accounting collectively for 44% of the administered dose collected over 48 hr) were identified in urine by GC/MS techniques, while only unchanged I (accounting for a further 12.8% and 23.5% of the dose in two rats) was present in extracts of feces.

The metabolic fate of stiripentol in man.

The metabolism of stiripentol (I), a new antiepileptic drug, was studied in healthy human subjects. Following a single 1200-mg oral dose to one subject, 13 metabolites of I were detected in urine and were identified by GC/MS techniques. The structures of 9 of these metabolites were confirmed subsequently by synthesis of the corresponding reference compounds.

Fetal death: coagulation defects and management. Report of 20 cases with study of the half-life of [125I]fibrinogen.

This report concerns 20 patients with intrauterine fetal death. Blood samples for coagulation studies were obtained before, during and after delivery. No clinical defibrination or bleeding was noted.

[Macroscopic examination of the fresh placenta. Statistical analysis of 1,200 cases. Comparison with maternal and neonatal pathology].

We have examined 1,200 placentas in a fresh state and have compared the results of these examinations with maternal pathology on the one hand and the neo-natal pathology on the other hand. It turns out that most abnormalities of pregnancy are associated in a significant way with the pathological findings in the placenta, and that the good or pathological health of the newborn is significantly associated with the normal of pathological character of the placenta. The principal weakness in this method of examination is the absence of information about infection.