European medical students should have acquired adequate prescribing competencies before graduation, but it is not known whether this is the case. In this international multicenter study, we evaluated the essential knowledge, skills, and attitudes in clinical pharmacology and therapeutics (CPT) of final‐year medical students across Europe. In a cross‐sectional design, 26 medical schools from 17 European countries were asked to administer a standardized assessment and questionnaire to 50 final‐year students. Although there were differences between schools, our results show an overall lack of essential prescribing competencies among final‐year students in Europe. Students had a poor knowledge of drug interactions and contraindications, and chose inappropriate therapies for common diseases or made prescribing errors. Our results suggest that undergraduate teaching in CPT is inadequate in many European schools, leading to incompetent prescribers and potentially unsafe patient care. A European core curriculum with clear learning outcomes and assessments should be urgently developed.

The knowledge of the pharmacodynamic interactions between fluoroquinolones and antifungal agents may guide selection and potentially improve the outcome of immunosuppressed patients with concurrent bacterial and fungal infections.

Patients suffering from invasive mycoses often receive concomitant antifungal therapy and antibacterial agents. Assessment of pharmacodynamic interactions between antifungal and antibacterial agents is complicated by the absence of a common antifungal end point for both agents. Ciprofloxacin has no intrinsic antifungal activity but may interact with antifungal agents, since it inhibits DNA gyrase (topoisomerase II), which is abundant in fungi. We therefore employed isobolographic analysis adapted to incorporate a nonactive agent in order to analyze the potential in vitro interaction between the fluoroquinolone ciprofloxacin and several representative antifungal agents against Candida albicans and Aspergillus fumigatus strains by using a microdilution checkerboard technique. In agreement with earlier in vitro studies, conventional fractional inhibitory concentration index analysis was unable to detect interactions between ciprofloxacin and antifungal agents. However, isobolographic analysis revealed significant pharmacodynamic interactions between antifungal agents and ciprofloxacin against C. albicans and A. fumigatus strains. Amphotericin B demonstrated concentration-dependent interactions for both species, with synergy (interaction indices, 0.14 to 0.81) observed at ciprofloxacin concentrations of <10.64 g/ml. Synergy (interaction indices, 0.10 to 0.86) was also found for voriconazole and caspofungin against A. fumigatus. Isobolographic analysis may help to elucidate the pharmacodynamic interactions between antifungal and non-antifungal agents and to develop better management strategies against invasive candidiasis and aspergillosis.Candida and Aspergillus spp. are the most common pathogens causing life-threatening invasive fungal infections in immunocompromised patients (22,25,41). Patients at risk for these invasive fungal infections are also at risk of developing other opportunistic infections, for which a wide range of nonantifungal therapeutic agents is used for prophylactic and therapeutic purposes concomitantly with antifungal agents (2). A potential interaction between these agents and antifungal agents may affect antifungal efficacy, with potentially important implications for clinical outcome.Fluoroquinolones are broad-spectrum antibacterial agents that act on DNA gyrase (topoisomerase II) and topoisomerase IV, resulting in inhibition of DNA replication, recombination, and transcription, and ultimately bacterial death (40). Although fluoroquinolones have no intrinsic antifungal activity, high levels of topoisomerase I and II have been reported in pathogenic fungi (6,34,35), offering a potential mechanism of interaction between fluoroquinolones and antifungal agents. Shen and colleagues demonstrated that an isothiazoloquinolone inhibited Candida albicans topoisomerase II (34). Sugar et al., Sasaki et al., and Nakajima et al. demonstrated in vivo enhancement of antifungal activity by combined fluoroquinolone therapy (19,29,36). However, most in vitro studies using conventional fractional inhibitory con...

Behaviour regarding ABs complied with emotions and knowledge in all countries. The results of this study may lay a basis for conducting national public campaigns, as a step forward in education of patients on rational AB use.

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