INDICES> Malaria drugs response (4)

[Dr N Cameron <camern@hltrsa.pwv.gov.za>]

Malaria drugs response (4)
_______________________


This is a follow up to the message posted last week by Ian Couper and cross
posted to this list from Drug-Info
.
Doctors and nurses treating  malaria are some what caught
between a rock and a hard place in KZN at present.
Due to an unpresidented demand as a result of the current malaria
epidemic, there has been a shortage of Fansidar and chloroquine in
KZN in a few hospitals. We have been assured by Roche that large
quantities of Fansidar(77 000 dosage packs!) have arrived and are
being distributed  (30 000 to KZN and the rest divided equally to
Mpumalanga and N Province) The Pharmaceutical  section of KZN are
working on the chloquine supply and hope to havethe problem sorted
very soon. Although stock levels haven't been optimal, there is no
current shortage of Fansidar in Northern Province or Mpumalanga.

There has been a recent study involving about 80 patients with
42 day followup which showed about 50%  failure rate following SP
alone treatmentin Ndumo! A smaller study done at Manguzi last year
showed a SP and chloroquine a failure rate of only 13%. Both these
results do need to be confirmed.  It appears that is SP resistance in
Mpumalalnga and N Province where SP has only been used for a far
shorter period is less than 10% quite acceptible for 1st line
treatment. SP has been used routinely  in KZN for over 10 years.

An expert rapid literature search has revealed  no robust evidence,
that either cotrimoxazole or  tetracycline are suitable for treatment
even in combination with other anti- malaria drugs.

An active group of programme and pharmacuetical people are
undertaking a project in all three malaria provinces  to test new
combinations of malaria drugs. The aim is to have much better
information based on local studies and if possible supplies of new
drugs for KZN available by Sept/Oct 2000!

On the basis of this and in consultation with a range of experts the
following advice and information is offered for doctors treating
malaria:

1. SP 3 tabs stat is still the firstline treatment of choice in SA
except in KZN.

2. In  KZN the combination of SP and chloroquin should
continue to be given, with quinine as backup. Health workers
should have a a high index of suspicion of failure  (no
clinical improvement and /or fever present after 3 days.) Extra
training may be required in this regard.

3. Although difficult, a full  7 days of quinine is the
backup treatment of choice. ( for outpatients, training
should include the fact that outpatients must expect frequent minor
side effects with quinine and should be motivated to take the full 7
days of treatment, and to return immediately if side effects become
intolerable rather than just abandon treatnment!)

4. The Provincial and  National Malaria Programmes will monitor the
malaria case numbers and  drug supply and distribution situation on a
weekly basis.

5. As soon as the results of the new drug studies become
available these will make these available. There are parallel
negotiations going on with the Medicines Control Council and the
provincial authorities to fast track registeration and availabality
such drugs.



-
Dr Neil Cameron
Director: Communicable Disease Control
Dept of Health
Private Bag X828
Pretoria
0001 South Africa


Tel: +27-12-312 0090
Fax. +27-12-323 8626
e-mail. camern@hltrsa.pwv.gov.za




--
Send mail for the `INDICES' conference to `indices@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to:  `owner-indices@usa.healthnet.org'.