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.
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
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.
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.
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.
[Control Selection - Control Spend - Control Service]
38 Milton Margai
Mobile: +232 79 82 72 00