Malaria drug wrongly prescribed
Oct 20, 2002
Feeling a little unwell, Julia went to a clinic of one of the health insurance providers in Kampala, hoping to get better
By Charles Wendo
Feeling a little unwell, Julia went to a clinic of one of the health insurance providers in Kampala, hoping to get better. But instead the treatment caused her trouble. More than a month later, she is not yet well.
Despite a negative malaria test, the doctor gave her one of the most agonising anti-malarial medicines — mefloquine.
Mefloquine is commonly sold under the brand name Lariam. “He said the malaria could be incubating so to be on the safe side I should take something,†she says.
Julia took four tablets, two daily for two days. Then the side effects came like an ambush. The doctor had not told her the tablets would cause any trouble. So when she got worse, she thought the malaria had successfully incubated. For the next three days she couldn’t walk, she had abdominal pain, felt confused and experienced scary dreams.
“The worst thing was failing to sleep, looking at the clock the whole night,†she recalls. “When I resumed work my thinking capacity was lower. I could read something a thousand times before it made sense.â€
After three weeks of agony, another doctor told her she was suffering from the side effects of mefloquine. He advised her to drink four litres of fluids daily to flush out the drug and its residues.
Normally any medic who prescribes medicine has a professional and ethical responsibility to tell a patient about the side effects, but Julia’s doctor didn’t. Now it is emerging that the drug was completely unnecessary.
Experts say that whereas all anti-malarial medicines have side effects, some like mefloquine are worse. Yet unlike other drugs that are excreted from the body within a few days, mefloquine lingers in blood for weeks, thus prolonging the duration of side effects.
According to the national malaria treatment guidelines, mefloquine is not supposed to be used for routine treatment.
The policy recommends a combination of chloroquine and SP (commonly known as fansidar) as the first line treatment and quinine as the second line.
Dr Peter Langi, Manager of the Malaria Control Programme, says ordinarily a Ugandan living in Uganda does not need mefloquine. “These drugs should really be reserved,†he says.
Because of its ability to stay in blood for long, the World Health Organisation recommends mefloquine for Europeans who stay for a limited period in countries that have malaria. The drug stays in blood waiting to pounce on any malaria parasites that a mosquito might inject in. This is referred to as prophylaxis.
However, prophylaxis is not recommended for people who live permanently in places like Uganda where malaria is common.
Of recent the number of private doctors prescribing mefloquine for routine treatment appears to be increasing. Langi says if for any reason a doctor has to give mefloquine to a patient, it has to be in a place where the doctor can observe the patient for some time.
The drug has always been know to cause dizziness, anxiety, confusion, nausea, abdominal discomfort, sleeplessness, nightmares and general weakness. But recently new side effects have emerged. And it appears all side effects are more common than doctors had expected.
While experts review research data on mefloquine, Langi says, Ugandan medics should stick to the malaria treatment guidelines. But his fear is that some private practitioners disregard the national treatment guidelines and prescribe medicines of their own preference.
“Clinics are in the private sector and it is very difficult for us to control them,†he says.
Feeling a little unwell, Julia went to a clinic of one of the health insurance providers in Kampala, hoping to get better. But instead the treatment caused her trouble. More than a month later, she is not yet well.
Despite a negative malaria test, the doctor gave her one of the most agonising anti-malarial medicines — mefloquine.
Mefloquine is commonly sold under the brand name Lariam. “He said the malaria could be incubating so to be on the safe side I should take something,†she says.
Julia took four tablets, two daily for two days. Then the side effects came like an ambush. The doctor had not told her the tablets would cause any trouble. So when she got worse, she thought the malaria had successfully incubated. For the next three days she couldn’t walk, she had abdominal pain, felt confused and experienced scary dreams.
“The worst thing was failing to sleep, looking at the clock the whole night,†she recalls. “When I resumed work my thinking capacity was lower. I could read something a thousand times before it made sense.â€
After three weeks of agony, another doctor told her she was suffering from the side effects of mefloquine. He advised her to drink four litres of fluids daily to flush out the drug and its residues.
Normally any medic who prescribes medicine has a professional and ethical responsibility to tell a patient about the side effects, but Julia’s doctor didn’t. Now it is emerging that the drug was completely unnecessary.
Experts say that whereas all anti-malarial medicines have side effects, some like mefloquine are worse. Yet unlike other drugs that are excreted from the body within a few days, mefloquine lingers in blood for weeks, thus prolonging the duration of side effects.
According to the national malaria treatment guidelines, mefloquine is not supposed to be used for routine treatment.
The policy recommends a combination of chloroquine and SP (commonly known as fansidar) as the first line treatment and quinine as the second line.
Dr Peter Langi, Manager of the Malaria Control Programme, says ordinarily a Ugandan living in Uganda does not need mefloquine. “These drugs should really be reserved,†he says.
Because of its ability to stay in blood for long, the World Health Organisation recommends mefloquine for Europeans who stay for a limited period in countries that have malaria. The drug stays in blood waiting to pounce on any malaria parasites that a mosquito might inject in. This is referred to as prophylaxis.
However, prophylaxis is not recommended for people who live permanently in places like Uganda where malaria is common.
Of recent the number of private doctors prescribing mefloquine for routine treatment appears to be increasing. Langi says if for any reason a doctor has to give mefloquine to a patient, it has to be in a place where the doctor can observe the patient for some time.
The drug has always been know to cause dizziness, anxiety, confusion, nausea, abdominal discomfort, sleeplessness, nightmares and general weakness. But recently new side effects have emerged. And it appears all side effects are more common than doctors had expected.
While experts review research data on mefloquine, Langi says, Ugandan medics should stick to the malaria treatment guidelines. But his fear is that some private practitioners disregard the national treatment guidelines and prescribe medicines of their own preference.
“Clinics are in the private sector and it is very difficult for us to control them,†he says.