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[e-drug] Ebola and Essential Medicine issues (3)

E-DRUG: Ebola and Essential Medicine issues (3)
[Last week you mentioned a WHO Interim list of drugs to treat Ebola.
In the absence of treatment guidelines, is this list really helpful?   Have  
treatment guideines been prepared?  BS Moderator]

A Pharmacy professional colleague based at one of our Up-Country Ebola 
Treatment Centers recently shared the following drug use event  which could not 
be readily explained in our social media forum.

 Day  1
On the 28th Dec, 2014, a 21-year old female patient was brought into the 
facility with an initial temperature of  37.80C, and complaining of abdominal 
pain. After routine triage, she was declared an Ebola-suspect and duly admitted 
with the following treatment

(1) Tabs Paracetamol 500mg,

(2) Tabs Cefixime 400mg, 

(3) Tabs Omeprazole 20mg,

(4) Tabs Vitamin C,

(5) Tabs Coartem 

(6) Ringers lactate 

(7) ORS. 

Day 2 

Patient's condition continued to worsen and blood sample was taken for the 
Ebola test. The abdominal pain did not subside and temperature was also rising. 

Day 3

Patient's condition deteriorated further, with marked increase in stool 
frequency; ranging between 3-5 times between temperature measurements. In the 
meantime, the lab
result came back positive for Ebola and she was therefore transferred to the 
ward. A  pregnancy test was negative.

Day 4

By now the  temperature had risen to 38.20C, with a rather severe  watery 
diarrhea. It was
then observed that ALL solid oral
dosage forms passed through the GIT, essentially unchanged.

Perhaps not surprisingly, initial views focused on drug quality. Even though 
there was no  consensus on this, the Drug Regulatory Authority instructed that 
samples of the drugs involved be collected for usual parameter testing. This 
process must be ongoing.

My personal, albeit speculative, view on this matter was that this was a case
of an Ebola-induced diarrhea which may have been of such extraordinary
nature that it may have correspondingly distorted GIT physiology in such a way
as to make drug transit time practically negligible.

Could there be any such past experiences on diarrhea  and drug GIT transit time 
How can such a situation be managed, bearing in mind that there are many  
clinicians who hold the view that the intravenous route, though attractive, 
presents significant infection control problems in situations such as Ebola?
Murtada M. Sesay BPharm.  MSc. MMI.  MCIPS.
Health Supply
[Control Selection - Control Spend - Control Service]
38 Milton Margai
College Road 
Sierra Leone
Mobile: +232 79 82 72 00
Email: kindiatown@hotmail.com                                     

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