NEW FINDINGS ON MALARIA
Coartem malaria drug works best, study finds, May 23 2007 at 01:37AM
By Julie Steenhuysen
Chicago - In the fight against drug-resistant malaria, a combination drug made by Novartis AG appears to work better than other recommended treatments, US researchers said on Tuesday, in a finding that might help guide treatment for
the deadliest form of the disease
Ugandan children who received the combination of artemethere-lumefantrine, also known as Coartem, had the lowest rate
of treatment failure of three leading combination therapies studied, researchers reported in the Journal of the
American Medical Association
Coartem is an artemisinin-based therapy or ACT, which have been shown to be more effective and to delay development of
the disease. Researchers compared it to two other treatments recommended by the World Health Organisation for
drug resistant malaria - another ACT therapy made by Sanofi-Aventis and a lower-cost combination drug.
'All ACTs should not be considered equivalent regimens'
Coartem fared much better than a competing ACT drug.
"All ACTs should not be considered equivalent regimens," Dr Grant Dorsey of the University of California, San Francisco,
and colleagues wrote.
But the study also showed the benefit of consistent, high quality care.
"Prompt delivery of treatment provided through health facilities involved in the study improved clinical outcomes,
even if less efficacious therapy was delivered," Drs Gianna Zuccotti and Catherine DeAngelis wrote in an editorial.
Malaria kills a million people a year, mostly children under age five in Africa south of the Sahara.
The mosquito-borne disease has grown resistant to older drugs that have been replaced by combination treatments,
especially to fight Plasmodium falciparum, the deadliest strain of the disease.
The researchers studied the three leading available combination therapies for treating uncomplicated falciparum malaria
for safety, effectiveness and tolerability between November 2004 and June 2006.
The trial included 601 children from an urban community in Kampala, Uganda, who were treated with one of three combination
drugs - amodiaquine plus sulfadoxine-pyrimethamine, amodiaquine plus artesunate, or artemether-lumefantrine.
Of the three combinations, artemether-lumefantrine fared best, with a risk for treatment failure of 6,7 percent.
Amodiaquine plus artesunate - a cheap therapy combining the artemisinin derivative artesunate with the older
antimalarial amodiaquine - had risk for failure rate of 17,4 percent.
Amodiaquine plus sulfadoxine-pyrimethamine, a low-cost combination of two older drugs, fared worst, with a risk for
failure rate of 26,1 percent.
"Our study suggests that the efficacy of amodiaquine plus sulfadoxine-pyrimethamine is decreasing in Kampala, " the researchers wrote.
The research was part of a JAMA special section on malaria.
Diarrhoea is a very common ailment when traveling.
Most cases of diarrhoea when traveling are mild and do not
require either antibiotics or anti-diarrhoea
Adequate fluid intake is essential for any
traveler suffering from diarrhoea, to prevent dehydration.
The most important aspect of preventing diarrhoea is
treatment and care, as far as food and water intake is
Travelers are advised to carry with them an
antibiotic as well as an anti-diarrhoea drug, to be taken as
soon as significant diarrhoea starts.(Three or more loose
stools in an 8-hour period or five or more loose stools in a
If diarrhoea is combined with nausea,
vomiting, cramps, fever or blood in the stool, an antibiotic
should be administered.
Ciprofloxacin (Cipro)(PDF) 500 mg
twice daily or
Levofloxacin (Levaquin) (PDF) 500 mg once
daily for a total of three days.
Quinolones are generally
well-tolerated, but occasionally cause sun sensitivity and
should not be given to children, pregnant women, or anyone
with a history of quinolone allergy.
treatment could be a three day course of rifaximin (Xifaxan)
200 mg three times daily or azithromycin (Zithromax) 500 mg
Rifaximin should not be used by those with
fever or bloody stools and is not recommended for pregnant
women or children under the age of 12.
be avoided in those allergic to erythromycin or related
An antidiarrhoea medicine such as loperamide
(Imodium) or diphenoxylate (Lomotil) should be taken as needed
to slow the frequency of stools, but not enough to stop the
bowel movements completely.
Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under the
age of 2.
If diarrhoea is, severe, bloody, or if fever
occurs accompanied by shivering and chills, or if abdominal
pain becomes severe, or if diarrhoea lasts for more than 72
hours, medical attention should be sought.
antibiotics are effective, they should not be taken as a
Food and water precautions;
Don't drink tap water unless
it has been boiled, filtered, or chemically disinfected.
Don't drink un bottled beverages or put ice in your drinks
unless you know that the ice is safe to drink.
fruit or vegetables unless they have been washed very
thoroughly peeled or cooked.
Avoid cooked foods that are no longer hot. because cooked food that has been left at room
temperature can be very dangerous.
Avoid un pasteurized milk and any products that might have been made from un pasteurized
milk.When using powdered milk make sure the water you mix it with is safe.
Avoid food and beverages obtained from street
Do not eat raw or undercooked meat or fish.
Inoculation regulations can change at short notice. Please get medical advice in the case of doubt.
Recommended for all travelers
Recommended for all travelers
One-time booster recommended for any adult traveler who completed the childhood series but never had polio vaccine as an adult.
For travelers who may have intimate contact with local residents, especially if visiting for more than 6 months.
For travelers who may have direct contact with animals and may not have access to medical care
Measles, Mumps, Rubella (MMR).
Two doses recommended for all travelers born after 1956, if not previously given.
Revaccination recommended every 10 years.
According to International Health Regulations, a valid Yellow Fever Certificate is required from all passengers over one year of age coming from an endemic area.
You must supply a yellow fever certificate issued at least 10 days before arrival in South Africa if you have travelled from or through a country with yellow fever. If you do not have a valid certificate, you will be denied entry into South Africa.
Countries for which a yellow fever vaccination certificate is required for entry into South Africa are:
Angola, Argentina, Benin, Bolivia, Brazil, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Colombia, Guinea-Bissau, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Ecuador, Equatorial Guinea, Ethiopia, French Guyana, Gabon, Gambia, Ghana, Guinea, Guyana, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Panama, Paraguay, Peru, Rwanda, São Tomé and Principe, Senegal, Sierra Leone, Somalia, Sudan, Suriname, Togo, Trinidad
INFORMATION ON HEALTH AND MEDICAL FACILITIES
Maputo has private and public medical facilities, whilst in the rest of Mozambique apart from Beira, medical facilities and care are either non existent or very basic.
Very few medical institutions accept credit cards so prepare for cash payments if you need medical help.
In the more rural areas medical practioners and staff often do not speak fluent English.
The availability of medicines and drugs is a problem, they very often are not available and re-supply is erratic.
Comprehensive medical insurance is essential and it is recommended that tourists carry personal medical supplies and sterile syringes.with them
All medical facilities and centres outside Maputo require payment at the time of service, and may even ask for payment up front.
Many rural health centres were forced to close during the civil war.
Bring adequate supplies of all medications in their original containers, clearly labeled.
Carry a signed, dated letter from your doctor, describing all medical conditions and listing all medications, including generic names. If you carry syringes or needles,(Which is highly recommended), make sure that you carry the above doctors letter confirming their necessity.
Pack all medications in hand luggage. Carry a duplicate supply in your packed luggage.
If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.
HIV/AIDS is a major danger in Southern Africa and responsible precautions are of major importance, when indulging in sexual practices with strange partners.
Maputo's night life is renowned but care has to be exercised when partaking of the pleasures of the flesh because of the very very real danger of HIV/AIDS.
Diarrhoeal diseases, giardiasis, dysentery and typhoid fever are all common.
Bilharzia (schistosomiasis) is present.
Avoid swimming and paddling in fresh water; swimming pools which are well chlorinated and maintained are safe.
Hepatitis A, B and E are present. Meningococcal meningitis may occur. Human trypanosomiasis (sleeping sickness) has been
reported. Plague has been reported in remote areas. Visitors should also be wary of the dangers of tetanus.
Rabies is present. For those at high risk, vaccination before arrival should be considered. If you are bitten, seek medical
advice without delay.
SUNBURN:- Take plenty of sunblock of a high factor and stay out of the direct sun in the middle of the day.