E-DRUG: Concurrent use of Co-trimoxazole and ACT in children (2)
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Dear Dr Koleade,
You are presenting an interesting question to E-drug. The comment of the moderator KM answers most of the questions. However, I should like to add a few remarks. The treatment of malaria with Artesunate SP involves a full treatment of SP administered as a single dose. This sulfonamide does have a long elimination half life but due to a very high protein binding it can only exert a proper antiparasite and antimicrobial action for about five days, in some case maybe a little longer. Pyrimethamine will be active for quite a longer time.
During this period of 5 to 8 days it does not make sense to add another short acting sulfonamide like sulfamethoxazole in combination with timethoprim. The sulfonamide addition may create problems e.g (crystalluria) and will definitely not improve the patients condition (there is nothing to begained by having higher concentrations than Cmin for the free fraction in plasma water (non protein bound concentration).
Recommendation: do not give Co-trimoxazole in the first 3 - 5 days after starting Artesunate + SP.
This problem can be overcome if for the malaria treatment another ACT is being used. For example Co-arinate (Dafra Pharma). In this medicament Artesunate is given over 3 days but the sulfonamide/pyrimethamine combination is spread over 3 days. It was calculated that with this regimen the folic acid inhibition will last between 12 and 18 days. This should be sufficiently long to treat nearly all concommittant infections sensitive to sulfonamide therapy. Hence, no need for co-trimoxazole.
For a discussion on sulfonamides and the differences see the website www.dafra.be.
Best regards
Dr. F.H. Jansen
Dafra Pharma nv
2300 Turnhout
Belgium
www.dafra.be
Fhjansen@skynet.be
E-DRUG: Adherence of Private Practitioners with TB Guidelines in Pakistan
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Dear E-Druggers,
T.B is a leading cause of death among people in developing countries like
Pakistan and instead of increasing efforts the problem is still on the rise.
The study conducted in a district of Pakistan emphasizes the need for
training of private practioners who are being ignored in the efforts for
improving T..B treatment out comes while more than 80% of the patients are
attended in private sector for treatment.
Azhar Hussain, Zafar Mirza, Farrukh A Qureshi, Assad Hafeez.
Adherence of Private Practitioners with the National Tuberculosis Treatment
Guidelines in Pakistan: a survey report
J Pak Med Assoc Jan 2005;55(1):17-9.
Rawalpindi
Objective: In Pakistan, over 80% of the patients suffering from TB consult a
private practitioner for the initial evaluation. A cross-sectional survey
was conducted in seven thickly populated urban communities of Rawalpindi
district to evaluate the adherence of private practitioners with TB
treatment guidelines as laid down by National Tuberculosis Control Programme
(NTP) in Pakistan. The data was collected over 30 days. Methods: A young
lean man was simulated to act as a TB patient and was provided with a chest
X-ray suggestive of TB and two Acid-Fast Bacilli (AFB) positive sputum
reports. Only those prescriptions were included for analysis which either
had recognized the patient having TB or had any TB drug written in the
prescription. Results: A total of 77 practitioners were visited.
Prescriptions of 53 general practitioners fulfilled the inclusion criteria
and were analyzed. Only 2 (3.7%) prescriptions out of 53 met the required
standard for TB patients as laid down by NTP. Eighty three percent (n = 44)
favored a combination drug for the treatment while the rest preferred
individual preparations. Conclusions: The study reflects the lack of
knowledge about standardized TB treatment protocols amongst the private
practitioners in Pakistan. Public Private Partnerships between government
public health departments and non-governmental organizations working in
public health can be a valuable tool in generating mass awareness campaigns
(JPMA 55:17;2005).
Azhar Hussain
Acting Director (Assistant Professor)
Hamdard Institute of Pharmaceutical Sciences
Hamdard University, Islamabad Campus
F-8 Markaz, Islamabad.
Tel:00-92-51-2856901 Ext: 217
Fax: 00-92-51-2856433
azhar_hussain@hamdard-isb.edu.pk