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[e-drug] Ebola and Essential Medicine issues (2)- Use of diuretics

E-DRUG: Ebola and Essential Medicine issues (2)- Use of diuretics
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A couple of months ago, I got a call from a prominent local journalist friend 
of mine who
asked an otherwise simple question for a pharmacist; "What is a diuretic;
and what role does it have in the treatment of Ebola?" However, I have
learnt over my long career that when a journalist asks a professional question,
regardless of personal relationship, one's 
response should always take into account how this may be reported in the
ensuing newspaper article! I therefore probed a bit more why my friend was
asking such a question in the context of Ebola.

It then became clear to me that there had been a disagreement among clinicians 
in one of
our main Ebola Treatment Centers regarding the use of diuretics, in this case
Furosemide, in Ebola patients. Details of this disagreement were
subsequently published  in the UK newspaper; The Guardian. 
(http://www.theguardian.com/world/2014/dec/22/ebola-untested-drug-patients-sierra-leone-uk-staff-leave).

The issue was that, on the one hand, some British volunteers attached  to the 
22-bed treatment centre run by an
Italian NGO "Emergency", were not convinced about the usefulness of
diuretics in patients with kidney failure as a result of the virus. On the other
hand, the NGO explained that  their rationale
was to  rehydrate patients and then use
diuretics to "FLUSH" the kidneys. 
Not being a clinician, it would have been very
difficult for me to predict such a use of a diuretic.

It is worth noting that WHO has published an "Interim list of WHO essential
medicines necessary to treat Ebola cases based on existing guidelines 
(http://www.who.int/medicines/areas/medicines_list_ebola_07nov.pdf)
 and version 07 November 2014 indeed
includes Furosemide Injection: 10mg/ml in 2 ml ampoule and
10mg, 20mg or 40 mg tablets. However, the stated indication is 
"In case of overload of fluids".

The questions therefore are; is there a clinical basis for
flushing Kidney in Ebola patients, and can the use of Furosemide in such a 
context be justified? 
An even more worrying question is; how many lives that could otherwise have 
been saved perished due to this intervention?
We may of course never know the answer to the latter question, but we could save
lives in the future if this matter is given the attention it deserves.

Murtada M. Sesay BPharm.  MSc. MMI.  MCIPS.
Health Supply Matters
[Control Selection - Control Spend - Control Service]
38 Milton Margai
College Road 
Goderich,
Freetown
Sierra Leone
Mobile: +232 79 82 72 00
Email: kindiatown@hotmail.com

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