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Dans cette époque marquée par un allongement progressif de l’espérance de vie, les questions de polymédication et de qualité de prescription chez le sujet âgé sont primordiales. Plus une personne vit longtemps, plus elle peut développer des pathologies liées au vieillissement et consommer une multitude de traitements. Une prescription appropriée chez le patient âgé est un enjeu de santé individuelle et de santé publique. Les patients âgés sont potentiellement plus à risque de subir les effets indésirables liés à la prise concomitante de multiples médicaments.
L’objectif de ce travail est double :
1) Appréhender le concept de la polymédication afin d’en comprendre sa prévalence en médecine générale, ses causes et ses implications. Découvrir s’il existe des outils scientifiques pour nous seconder dans notre pratique quotidienne afin d’optimaliser nos prescriptions chez le sujet âgé.
2 ) Etablir une « photographie » de la problématique de la polymédication dans notre pays via une étude de terrain : en évaluer sa fréquence et déterminer s’il existe des caractéristiques associées à la polymédication sur une population de patients âgés fragiles, de plus de 75 ans, venant du domicile ou d’une MR/MRS, et hospitalisés aux Cliniques Universitaires Saint-Luc.
Résultats
Divers critères d’évaluation de la prescription chez le sujet âgé sont présentés dans la littérature scientifique. Dans ce travail, je présente les listes de critères d’évaluation les plus récentes et les plus complètes (liste réactualisée de M. Beers, liste française de M.L. Laroche et liste irlandaise STOPP et START de P. Gallagher). Ces outils permettent de sensibiliser le médecin traitant à une prise en charge plus appropriée chez le sujet âgé et sont un soutien pour une revue optimale des traitements. Néanmoins, leur application quotidienne en médecine générale est irréalisable et aucune étude prospective randomisée n’existe afin d’évaluer si leur utilisation permet de réduire la morbidité et la mortalité chez le sujet âgé.
Dans l’étude que j’ai réalisée, le taux de polymédication (défini par un nombre de médicaments au-delà de quatre) s’élève à 77%. Le nombre moyen de médicaments pris par le patient atteint 6.87

Aged --- Inappropriate Prescribing --- Polypharmacy --- Cross-Sectional Studies

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Aged --- Drug Prescriptions --- Prescription Drug Overuse --- Diabetes Complications --- Prescription Drug Misuse --- Inappropriate Prescribing

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inappropriate prescribing --- drug problems --- drug efficacy --- drug safety --- evidence based medicine --- health technology assesment --- Evidence-based medicine --- Clinical medicine --- Evidence-based medicine. --- Decision making --- Decision making. --- Serbia. --- EBM (Medicine) --- Evidence-based healthcare --- Systematic reviews (Medical research) --- Medicine, Clinical --- Medicine --- N.R. Serbii͡ --- Narodna Republika Srbija --- NR Serbii͡ --- People's Republic of Serbia --- Republic of Serbia --- Republika Srbija --- RS de Serbije --- Serbia and Montenegro --- Serbii͡ --- Servia --- Socialist Republic of Serbia --- Socijalistička Republika Srbija --- Sot͡sialisticheskai͡a Respublika Serbii͡ --- SR Srbija --- Srbija --- SRS --- Szerbia

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There has been much speculation about a possible antibiotic Armageddon; this would be the result of having untreatable post-operative infections, and similarly untreatable complications after chemotherapy. The now famous “O’Neill Report” (https://amr-review.org/) suggests that more people could die from resistant bacterial infections by 2050 than from cancer. We are still learning about all the subtle drivers of antibiotic resistance, and realizing that we need a single “whole of health” co-ordinated policy. We ingest what we sometimes feed to animals. There do not seem to be any new classes of antibiotics on our horizon. Perhaps something that has been around “forever” will come to our rescue—bacteriophages! Nevertheless, we have to do things differently, use antibiotics appropriately, for the correct indication, for the correct duration and with the correct dose, and with that, practice good antibiotic stewardship. Whilst by no means comprehensive, this book does cover some of the many topics of antibiotic stewardship. It also addresses some of the older antibiotics, some new combinations, and even some new agents. Last, and by no means least, there are two excellent articles on bacteriophages.

Medicine --- Antimicrobial resistance --- antibiotics --- antimicrobial stewardship --- inappropriate prescribing --- days of therapy --- Start Smart then Focus --- piperine --- piperlongumine --- antibacterial --- antifungal --- synergy --- non-target feed --- florfenicol --- thiamfenicol --- chloramfenicol --- HPLC–MS/MS --- validation --- swine --- out-of-hours care --- primary care --- quality of care --- quality indicators --- practitioners cooperative --- antibiotic stewardship --- fluoroquinolones --- guidelines --- urinary tract infections --- quality improvement --- general practitioners --- guideline --- health inequalities --- health equity assessment tool --- public health --- Enterobacteriaceae --- carbapenem-resistant --- CRE --- antibiotic resistance --- antimicrobials --- bacteriophages --- biofilms --- novel antimicrobials --- Antibiotics --- resistance --- broad-spectrum agents --- hospital epidemiology --- antibiotic utilization --- infection control --- infection prevention --- Pseudomonas aeruginosa --- Acinetobacter baumannii --- extended-spectrum beta-lactamases --- carbapenem-resistant Enterobacteriaceae --- methicillin-resistant Staphylococcus aureus --- clinical trials --- infectious disease --- phage therapy --- silver complexes --- camphorimine --- anti-Candida activity --- antifungals --- antibacterials --- efflux inhibitors --- efflux pumps --- erm(41) --- mutations --- mycobacteria --- verapamil --- actinomycetes --- bioactivity --- polyketides --- polyketide synthases --- biosynthesis --- antimicrobial resistance --- economic evaluation --- cost-utility analysis --- cost-effectiveness analysis --- policy analysis --- One Health --- Singapore --- antibiotic prescribing --- implementation --- behavior change --- stakeholder consultation --- n/a --- HPLC-MS/MS

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There has been much speculation about a possible antibiotic Armageddon; this would be the result of having untreatable post-operative infections, and similarly untreatable complications after chemotherapy. The now famous “O’Neill Report” (https://amr-review.org/) suggests that more people could die from resistant bacterial infections by 2050 than from cancer. We are still learning about all the subtle drivers of antibiotic resistance, and realizing that we need a single “whole of health” co-ordinated policy. We ingest what we sometimes feed to animals. There do not seem to be any new classes of antibiotics on our horizon. Perhaps something that has been around “forever” will come to our rescue—bacteriophages! Nevertheless, we have to do things differently, use antibiotics appropriately, for the correct indication, for the correct duration and with the correct dose, and with that, practice good antibiotic stewardship. Whilst by no means comprehensive, this book does cover some of the many topics of antibiotic stewardship. It also addresses some of the older antibiotics, some new combinations, and even some new agents. Last, and by no means least, there are two excellent articles on bacteriophages.

Antimicrobial resistance --- antibiotics --- antimicrobial stewardship --- inappropriate prescribing --- days of therapy --- Start Smart then Focus --- piperine --- piperlongumine --- antibacterial --- antifungal --- synergy --- non-target feed --- florfenicol --- thiamfenicol --- chloramfenicol --- HPLC–MS/MS --- validation --- swine --- out-of-hours care --- primary care --- quality of care --- quality indicators --- practitioners cooperative --- antibiotic stewardship --- fluoroquinolones --- guidelines --- urinary tract infections --- quality improvement --- general practitioners --- guideline --- health inequalities --- health equity assessment tool --- public health --- Enterobacteriaceae --- carbapenem-resistant --- CRE --- antibiotic resistance --- antimicrobials --- bacteriophages --- biofilms --- novel antimicrobials --- Antibiotics --- resistance --- broad-spectrum agents --- hospital epidemiology --- antibiotic utilization --- infection control --- infection prevention --- Pseudomonas aeruginosa --- Acinetobacter baumannii --- extended-spectrum beta-lactamases --- carbapenem-resistant Enterobacteriaceae --- methicillin-resistant Staphylococcus aureus --- clinical trials --- infectious disease --- phage therapy --- silver complexes --- camphorimine --- anti-Candida activity --- antifungals --- antibacterials --- efflux inhibitors --- efflux pumps --- erm(41) --- mutations --- mycobacteria --- verapamil --- actinomycetes --- bioactivity --- polyketides --- polyketide synthases --- biosynthesis --- antimicrobial resistance --- economic evaluation --- cost-utility analysis --- cost-effectiveness analysis --- policy analysis --- One Health --- Singapore --- antibiotic prescribing --- implementation --- behavior change --- stakeholder consultation --- n/a --- HPLC-MS/MS