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NANASI 5: August 2002

NANASI 5: August 2002

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In this issue of NANASI:    

  • News flash -- generic drugs 
  • As your patients move
  • Opportunistic infections:   Chronic diarrhea
  • Where to refer your patients:    In Nyanza, Rift Valley, and Western Provinces
  • Q & A:   Post-exposure prophylaxis (PEP) after needle sticks
  • "Sheet C" For Counselors : Caroline - planning to be married

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NEWS FLASH

NEW LAW BLOCKS IMPORT OF AIDS GENERICS INTO KENYA

"Desperate and dying, Kenya's 2.4 million HIV-infected people are unlikely to get cheap generic anti-retrovirals anytime soon, thanks to an amendment introduced into the country's patent law by the government barely one month after it came into effect.

"The amendment, published under the Statute Law (Miscellaneous Amendments) Act, 2002, in the Kenya Gazette Supplement dated June 7, makes it virtually impossible for any Kenyan to import generic AIDS drugs, reversing a key provision of the Industrial Property Act (IPA)....

"The new amendment says that importation of generic versions of patented drugs, including key anti-retrovirals can now only be done by the "owner of the patent or with his express consent,"  which means that anybody who wants to import a generic will have to get permission from the international pharmaceutical company that holds the patent - a near-impossible proposition...."  

-- From  The East African, July 1-7, 2002, page 4

AS YOUR PATIENTS MOVE...

Many people living with HIV and AIDS patients, as their illness progresses, decide to leave the area where they have been living and working. Often they want to return to their home area, sometimes with their young children.  You need to refer your patients to a clinic or hospital or home-based program that will continue their care and regular follow-up.

On page 3 is a list of places you can refer patients going to the western parts of Kenya -- IN NYANZA, RIFT VALLEY,  AND WESTERN PROVINCES

Other lists will follow in the months ahead:
IN CENTRAL AND EASTERN PROVINCES -- see NANASI  6 (Sep 02)
IN MOMBASA AND NAIROBI  -- see NANASI  7 (Oct 02)


OPPORTUNISTIC INFECTIONS:  CHRONIC DIARRHEA

Chronic diarrhea is defined as " three or more liquid stools a day, continuously or off and on, for more than one month."  While acute diarrhea can occur in any patient,  chronic diarrhea  usually is an  indicator of advanced HIV/AIDS infection. There are four steps in the management of a patient with chronic diarrhea.

1) Treat dehydration. Oral rehydration is best, and extra potassium can be given in the form of bananas, tomatoes, papayas or by potassium tablets. If the patient cannot tolerate oral fluids, intravenous solutions containing potassium can be used. They are: Lactated Ringers Solution (Hartmann's Solution) or normal saline to which 1 vial of 15 % potassium chloride (40 mmol. ) per liter has been added. (Intravenous dextrose solutions are not warranted in the rehydration of a diarrhea patient because they replace none of the salts which have been lost in the diarrheal stool.)
   
2) Learn if the stool contains blood (RBCs and/or WBCs) or if it is watery without blood cells. A microscopic examination of the stool will help to make this determination.  Microscopy also will show if the patient is infected with trophozoites of amoeba or giardia.
  
3) Give appropriate antibiotics.

    For bloody  stools (containing RBCs / WBCs) give:
    cotrimoxazole tablets 960 mg. bid for 5-7 days.
    or
    nalidixic acid tablets 1,000 mg. qid for 7-14 days.
    or
    norfloxacin tablets 400 mg. bid for 7 days.
        
    For watery stool (without RBCs nor WBCs) give:
    metronidazole tablets 500 mg. tid for 5 days.
    or
    cotrimoxazole tablets 960 mg. bid for 5-7 days
    and/or
    albendazole tablets 400 mg. bid for 14-21 days.  
                         
    Adjunct treatment for unremitting chronic diarrhea may be started after the above treatments have been underway for 3-5 days and visible blood has cleared.  These drugs only give symptomatic relief. Commonly used adjunct treatments are:

    loperamide tablets 2 mg. Give 1 tablet after each stool. Max 6 tablets / day.
    codeine phosphate tablets 30 mg. Give 1 tab. q 4-6 hrs as needed.
    dihydrocodeine  tablets 30 mg. Give 1 tab q 4-6 hrs. as needed.

4) Prevent future attacks of diarrhea by maintaining the patient's intake of cotrimoxazole for life. Give cotrimoxazole tablets 480 mg. bid for several months; then if there is no recurrence of diarrhea, one may reduce the dose to 480 mg. daily.  If the patient receives anti-retroviral therapy and there is good recovery of the immune system, one might consider stopping cotrimoxazole altogether.

If chronic diarrhea does not respond to the above treatments,  transfer the patient to a larger hospital center where more advanced diagnostic and treatment possibilities are available.

These drugs to treat chronic diarrhea are available from MEDS (July 02)

    cotrimoxazole tablets 480 mg. -- 1000 tablets for 518 Ksh.
    metronidazole tablets 200 mg. -- 1000 tablets for 199 Ksh.
    nalidixic acid tablets 500 mg. --  1000 tablets for 2930 Ksh.
    norfloxacin tablets 400 mg. -  100 tablets for 249 Ksh.
    potassium chloride 15%  IV solution (40 mmol./ 10 ml.vial) -- 1 vial for 33 Ksh.
    potassium slow release tablets 600 mg. -  500 tablets for 737 Ksh.
    Oral Rehydration Solution packets 500 ml. -- 50 packets for 182 Kshdihydrocodeine tablets (DF-118) 30 mg. --  100 tablets for 719 Ksh.
    loperamide tablets (Imodium) 2 mg. -- 1000 tablets for 409 Ksh.


WHERE TO REFER YOUR PATIENTS:
IN NYANZA, RIFT VALLEY, AND WESTERN PROVINCES


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