SK.
Chloroquin resistance is so high at the Kenyan Coast that we are in the
processs of removing it as a first line drug. In fact one of the major
I can certainly understand this, we have a similar experience here
(in the north, not where I live, we just get traveler's malaria),
but we still don't want Quinine to be used by PHC, because the
only thing that is going to happen if you give it as first line
drug, is that you will develop Quinine resistant Malaria. Not something
I'd like to contract :-)-O
I still treat simple cases with Chloroquine (and a proteinsynthesis
inhibitor such as doxycylin or erythromycin) under very close
observation and only give quinine if I can demonstrate RI-III.
problems we have is chloroquin overdose. A child presents with fever and
the mother gives him chloroquin, the child does not improve and is taken
to a private clinic where he is also given chloroquin again and then
taken to a dispensary or a health centre or outpatient department of a
district or a subdistrict hospital where he is given chloroquin again.
And? The same will happen to quinine.
Why don't you educate your patients, or rather train the PHC staff?
Patients with complications of malaria such as hypoglycaemia,dehydration
convultions are treated with appropriate medications eg IV dextrose for
hypogycaemia,dehydration with IV fluids ,fits with diazepam.Quinine is
given IM ( or IV if he is going to receve IV fluids to correct
dehydration). At any one time the hospital has 10-15 children in the
paediatric ward with malaria and all of them on quinine.
I still don't see the reason to give IMI. We give oral if they
are not vomiting and composmentes and IVI if otherwise.
We had a difficult time convincing the staff about using IM quinine.
So, the workload is not really the problem, isn't it?
We are now in the process of providing quinine to the rural health
facilities.
I think this is a rather dangerous thing to do.
There have been studies on plasma levels after IM and IV quinine from
Gambia and Kenya.Will send you the references after the holidays.
I'd like to see them and will send them to the man :-)-O
It is very encouraging to have the debate on quinine.
Indeed, the regular stuff on this list is a bit dry and sometimes
very PC :-)-O.
Maybe some expert on malaria will comment.
Dr Lichtman is the Consultant in Charge of ICU at the National Hospital
and very very experienced in severe and complicated Malaria. I'll
communicate
with him on this.
I am just physcian who deals with everything under the sun including
which includes all diseases including "syndrome of inadequate rsourses
for health" (SIRH).
So am I, though on the other beach :-)-O. However SIRH isn't really
affecting us yet.
el
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Swakopmund, Namibia ;____/ Domain Coordinator for NA-DOM (el108)
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