[e-drug] Prices of antimalarial combinations (cont'd)

[Gunnar Holmgren <gunnar.holmgren@kbh.uu.se>]

E-drug: Prices of antimalarial combinations (cont'd)
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Dear E-druggers,

In reply to the messages of Oliver Hazemba and Steve Toovey,
unless a cheaper version of co-artemether is available, the choice
that Zambia appears to be ready to opt for seems logical and
sound. Even the cheaper price of USD 2 per treatment quoted for
co-artemether by Steve Toovey is unacceptably high for an
essential drug that is used so widely in a setting where malaria is
still such a dominant cause of morbidity and mortality.

Sulphadoxine + Pyramethamine has an acceptable price and until
definite studies in Zambia show a high resistance level, its use can
be recommended. However it is known that when its "grace" period
is over, resistance levels increase rapidly and regular monitoring is
essential for its continued use.

Amodiaquine is a sound second choice since the recent Cochrane
review from Liverpool clearly showed that its efficacy in most areas
with high chloroquine resistance continues to be good. It was found
that there is no evidence of dangerous side-effects when it is used
for treatment only and the WHO warning about the danger of bone
marrow toxicity should have only related to its use in prophylaxis.
Unfortunately this general recommendation spilled over into an area
where such a side-effect has not been recorded. It has all the
advantages of chloroquine i.e cheap, quick acting, slow
development of resistance which starts as R1 resistance for many
years before moving on to R2 and R3 levels, low levels of
side-effects and these are not life-threatening. For use with
populations with partial immunity its "grace" period would be
considerably longer that of Sulphadoxine + Pyramethamine and
maybe by the end of that period a better and more reasonably
priced alternative would be available.

Gunnar Holmgren
Section for International Maternal and Child Health
Uppsala University
Uppsla, Sweden
e-mail: gunnar.holmgren@kbh.uu.se


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