E-DRUG: Use of antimalarial drugs for standby treatment (2)
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Dear Phillip,
Your enquiry about standby drugs for malaria in Vietnam was forwarded
to me for comment. I am surprised that you mention chloroquine and
fansidar were the drugs mainly used as a stand by, as there is a very
high level of resistance to these drugs - I don't know the exact figures
from Vietnam, but I am sure it is well over 60% for Chloroquine and 50%
for Fansidar (in Cambodia, chloroquine can only be used in a very limited
area of Rattnakiri; likewise Fansidar is used in only a limited area of
Mondolkiri and Rattanakiri). I would have expected rather, wide spread
use of the artemisinin compounds - which are manufactured in Vietnam
(and spread from there to much of the rest of Southeast Asia). The
rapid and indiscriminate spread of these drugs certainly has a lot of
problems, but it is credited with the very rapid decline in malaria
mortality in Vietnam over the past 5 years. So without comment about the
use of stand-by drugs, I would think chloroquine or fansidar would be
almost useless and the people would take artesunate or artemisinin instead.
Chemoprophylaxis, will almost surely never be recommended
Stand-by treatment was used by gem-miners entering Pailin in Western
Cambodia from Thailand in the late 1980's/early 90's. You should contact
Dr. Valaikanya Plasai at the Thai malaria division for details (she did her
Ph.D. on the gem miners of Borai and has a lot of experience with
stand-by treatment. She can be contacted through the web page of
ACTMalaria <www.actmalaria.org>. There, at that time, I am almost sure
they were using mefloquine or fansimef, now given the choice, they
would probably use artesunate or artemisin.
You should also contact Dr. Allan Schapira, who is the WHO malaria
advisor at IMPE in Hanoi. I have an old e-mail address for him,
202968@mcimail.com, but you should be able to find either t he IMPE or
WHO numbers in Hanoi and contact him directly. There is a lot of work
going on in the region dealing with private drug sellers (much of it funded
through WHO/TDR) some of these studies are going on in Vietnam --
these studies include many of your questions about packaging and
community education. Allan should be able to fill you in. In any event,
there are tremendous resources and knowledge about malaria drugs in
Vietnam, available through IMPE - you should be in contact with them.
Sincerely,
Michael Macdonald, Sc.D.
BASICS
Washington DC
Email: MMACDONA@basics.org
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