E-drug: Re: Malaria and antimalarials (cont)
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Dear Dr. Steve Toovey,
You wrote: It is not clear to me George whether you support plain
(montherapy) artemisinins being available ("Let the plain and combination
products co-exist") or whether you feel they should not be available
("Striking plain Artemesinin derivatives off the model list is a convincing
strategy").
I don't favor monotherapy, it was a balanced view of major issues at stake.
You know we have patients who can't take combination products, as explained
in the earlier submission.
I wrote that those who can not take combination products should be able to
use plain artemesinins -- together with another antimalarial, not
necessarily the one in the product(s). This is happening with quinine. I
have not yet seen a combination product of quinine. But we administer
doxycycline, tetracycline or SP with a quinine course.
And our major worry is not because available products of quinine are plain.
Our major worry is that most health workers give underdoses of quinine. I
even quoted an example of Rifampicin, Rifampicin/Isoniazid combination, and
noted that there is a genuine demand for plain Rifampicin. Some one at
policy level had a sincere reason that resulted in avoiding plain
Rifampicin, yet patients exist who need it! Patients who will not be able
to use pre-formulated combinations of artemesinin or artemesinin derivatives
exist.
In addition, Dr.Jensen of Germany explained the challenging problems of
formulating combination products of artemesinin derivatives into certain
dose forms. The cost of this process will certainly reflect in the ultimate
price at the pharmacy outlet. How many companies will be able to
manufacture combination products of artemesinin derivatives for poor people
in the near future? Do you notice a lack of competition, higher prices for
a little while. (Economists know that prices reduce because of
competition).
At the moment a number of Agencies are stressing access. Any desires to
help Africans in the area of antimalarials, and their use need also to be
geared towards a multidisciplinary approach: Public sensitisation, Education
of health workers and more Research in drug development.
Steve I exceedingly acknowledge, as far as ensuring combination therapy is
concerned, that it is easier, more convenient to administer combination
preparations. Nevertheless, we should approach the idea of removing plain
artemesinins from the model list with a broader perspective. Afterall, the
major avoidable cause of rapid development of resistance to highly
effective, affordable antimalarials has to do with incorrect use. Once
again, this is my stand: Let plain artemesinins, combination products
co-exist on the model list.
Regards,
George Kibumba, MPS
Teaching Assistant, Clinical Pharmacy, Dept Of Pharmacy, Makerere
University,
P.O.BOX 7072, KAMPALA (UGANDA, E.AFRICA)
e-mail: kibumba@yahoo.com
[For the sake of treating TB patients, I do hope you are not having many
patients needing rifampicin for other indiactions - and that you manage to
keep the use restricted! KM, moderator]
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