E-DRUG: Use of Maloprim as malaria chemoprophylaxis (2)
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Dear E-druggers
In reply to Kae Ting Trouilloud's question about the use of pyrimethamine +
dapsone as malaria chemoprophylaxis, this product is no longer advocated in South Africa, nor is it available. Guidelines for the prevention of malaria in South Africa were published in May 2003 - see http://www.doh.gov.za/docs/factsheets/guidelines/malaria/prevention.pdf
The commonly used agents are mefloquine, doxycycline and, to a lesser extent, chloroquine + proguanil. Atovaquone-proguanil is a recent entrant to the market, and, although expensive, is becoming more widely used. It has been aggressively marketed through travel clinics which sell the item, thus gaining from the additional revenue. This started even before the product was registered, through widespread use of "named patient" provisions in the local Medicines Act. With the exception of cloroquine and proguanil, all effective malaria chemoprophylactics are prescription-only medicines, which does hamper access to some extent.
The guideline document also provides a map of South Africa, showing areas of different risk and the advice for various categories of patients visiting such areas. Many parts previously considered "high risk" have been "down-graded", particularly in KwaZulu-Natal (KZN) province.
Those interested may also want to look at the treatment guidelines - see http://www.doh.gov.za/docs/factsheets/guidelines/malaria/treatment/index.html. These were issued in August 2002 and there have been some changes in practice since then, with some variations between provinces. For example, KZN uses artemether plus lumefantrine (Coartem.), whereas Mpumalanga Province uses sulfadoxine-pyrimethamine (SP) and artesunate.
The last national notifiable disease report (for January to September 2004) shows 11243 cases of malaria and 73 deaths (for a case fatality rate of 0.6%). That's a bit higher than the corresponding period in 2003 (56 deaths and 8798 cases, also with a CFR of 0.6%). For more details see http://www.doh.gov.za/issues/malaria/statistics.html
But, returning to pyrimethamine + dapsone - this product was widely used in Zimbabwe in the past. Can anyone confirm whether this is still the case?
regards
Andy