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Amphotericin B Toxicities Among HIV Infected Adults with Cryptococcal Meningitis in Kiambu District Hospital

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Amphotericin B Toxicities Among HIV Infected Adults with Cryptococcal Meningitis in Kiambu District Hospital PJK THE Pharmaceutical Journal of Kenya Vol. 23 No. 4/2018 ISSN 2411-6386 FEATURE ARTICLE: Amphotericin B toxicities among HIV infected adults with Cryptococcal Meningitis in Kiambu District Hospital OFFICIAL JOURNAL OF THE PHARMACEUTICAL SOCIETY OF KENYA EDITOR IN CHIEF CONTENTS Prof. Jennifer A. Orwa, PhD, MSc, B.Pharm, FPSK, OGW Editorial: Substandard and Counterfeit Drugs; A 112 EDITORS Threat to Health Dr. Apollo Maima, PhD, M.Pharm, B.Pharm, MPSK Dr. Eveline Wesangula, M.Pharm, B.Pharm, MPSK Amphotericin B toxicities among HIV Dr. Nelly G. Kimani, B.Pharm, MPSK Dr. Lucy Tirop, PhD, B.Pharm, MPSK infected adults with Cryptococcal 113 Dr. Tabitha Ndungu, B.Pharm, Msc Psych, MPSK, MFIP Meningitis in Kiambu District Hospital Dr. Sara Agak, BPharm, MPSK Dr. Michael Mungoma, BPharm, MSc Toxicology, MPSK Impact of devolution on the trends Dr. Betty Mbatia, PhD, MSc. of Paediatric Malaria Admissions and 117 Dr. Mwangi Mugo, PhD, BPharm, MPSK Mortality in Homa-Bay County, Kenya- Dr. Francis Wafula, PhD, MPH, BPharm, MPSK An Interrupted Time Series Analysis ASSISTANT EDITOR Evaluating Corchorus Olitorius Plant Dr. Nadia Butt, B.Pharm, H.BSc., MPSK Mucilage in the formulation of Oro- 122 Dispersible Paediatric Sildenafil PSK NATIONAL EXECUTIVE COUNCIL (NEC) MEMBERS tablets Dr. Louis Machogu President Dr. Qabale Golicha Deputy President Presence of Potentially Harmful Dr. Juliet Konje National Treasurer Dr. Daniella Munene CEO Alcohol Excipients in Paediatric 126 Dr. Paul Mwaniki Ex-officio Medicine Dispensed in Nairobi Dr. Sultan Matendechero Member Dr. Laban Chweya Member The Occurrence of Glucose 6 Dr. Michael Mungoma Member Phosphate Dehydrogenase Deficiency 133 Dr. Nelly Kimani Member amongst Blood Donors at the Dr. Timothy Panga Member Regional Blood Transfusion Centre- Dr. Aneez Raemtulla Member Mombasa, Kenya PUBLISHED BY: Provider perspectives on the Pharmaceutical Society of Kenya Hurlingham, Jabavu Road Strengths and Weaknesses of the 135 PCEA Foundation, Block C Rm.22 Devolved Health Care in a Rural P.O. Box 44290-00100 GPO Nairobi, Kenya County in Kenya Tel/Fax: +254 20 2738364/18 Mobile: +254 722 817 264/723 310 942 Guidelines for Contributors E-mail: [email protected] 137 Website: www.psk.or.ke DESIGN AND LAYOUT Commwide Concepts The Pharmaceutical Society of Kenya (PSK) is a P.o. Box 12227-00100, Nairobi. Tel: 0710 262 294 representative organization that was formed enabling E-mail: [email protected] Pharmacists’ to employ their professional expertise in the care of patients. DISCLAIMER The views expressed in The Pharmaceutical Journal of Kenya are those of Established in 1964, PSK has its roots in the the respective authors and do not necessarily reflect those of the Editor- Pharmaceutical Society of East Africa, which was in-Chief or Members of the Editorial Board or those of the Pharmaceutical Society of Kenya. The Editor welcomes contributions from registered in 1950. Since its formation, PSK continues readers on subjects of interest to the Pharmaceutical industry and the to promote a common standard for professional health sector in general. Articles may be shortened or modified for clarity conduct and code of ethics for its members, as well as or brevity or rejected in totality without assignment of reason or explana- advocate for the welfare of Pharmacists. tion. 111 Vol. 23, No 4/ Pharmaceutical Journal of Kenya / 2018 EDITORIAL SUBSTANDARD AND COUNTERFEIT DRUGS; A THREAT TO HEALTH Judy Asin & Nadia Butt Globally the ever-present issues of substandard medicines and pharmaceutically equivalent to the originator or remain a challenge. World Health Organization (WHO) original drug. The large numbers of generic products locally defines substandard medicines as genuine medicines may hamper pharmacovigilance efforts allowing the provided by the manufacturer which do not meet quality infiltration of substandard and counterfeit medicines. specifications set for them by national standards. Circulation of substandard drugs is encouraged by the fact Substandard medicines include products with poor that drugs manufactured for export are often not regulated physical characteristics (for example friable tablets), to the same standard as those manufactured for domestic inadequate quantity of the active ingredients, poor use. In developing countries there is an abundance of dissolution or bioavailability profiles and those that are small-scale suppliers who may supply the substandard or poorly packaged and/or labeled. Counterfeit medicines on counterfeit medicines. the other hand can be described as medicines that are Substandard medicines may pose various risks to the deliberately and fraudulently mislabeled with respect to population. Product contamination can lead to toxicity and identity or source. They may contain the wrong active fatalities as highlighted by various cases in literature. In ingredient or no active ingredient and are of lesser value October 2004, a doctor working for Medicines Sans Frontier than the genuine product. Substandard medicines are in Darfur reported that a local donation of ringer’s lactate often produced by licensed manufacturers but counterfeits was contaminated with fungal growth. The death of 86 can be produced in backyards, small industries or even at children in Haiti in 1996 after ingestion of paracetamol that home. contained the anti-freeze diethylene glycol, which led to The Kenyan market is flooded with various generic acute kidney failure in those who ingested it, is another medicines and it is not always indicative that the products grave example. Recently in Kenya, some batches of still meet expected quality once they have been granted gentamycin injection were recalled as they were reported marketing authorization. Certain loopholes, particularly to cause adverse reaction of severe headaches. On the illegal importation of medicines via the country’s porous worldwide front, all valsartan medications formulated using borders, allow substandard and counterfeit medicines to drug from a Chinese manufacturer were recently recalled enter the drug supply chain. These defective medicines due to contamination of the active pharmaceutical may be subject to illegal hawking and sale or may indeed ingredient with a carcinogenic impurity. The presence of find their way into the authorized supply chain. At their suboptimal amounts of active pharmaceutical ingredient very best, these medicines are ineffective to the patient and compromises the treatment causing progression of the at their very worst, they tend to cause harm to the patient, disease, antimicrobial resistance, increased morbidity and promote development of drug resistance and increase mortality rates. A study done in Nigeria in 2001 found out morbidity and mortality rates. that almost half of randomly samples antibiotics and antiparasitics did not comply with the pharmacopoeia Pharmacy and Poison’s Board (PPB) is the national limits, containing less amounts of the active pharmaceutical medicines regulatory authority in Kenya and together with ingredient, thus posing and a threat of development of the analytical arm of National Quality Control Laboratory antimirobial resistance and hence prolonged illness. The (NQCL) and Drug Analysis and Research Unit (DARU) social and economic effects of substandard medicines ensure that pharmaceutical products are actively regulated cannot be ignored. The patient using these ineffective and comply with set specifications for safety and medicines may lose confidence in health care professionals effectiveness. However, these bodies face major challenges including their physician and pharmacist and potentially in the bid to protect the public from substandard and modern medicine as a whole. These patients also suffer counterfeit drugs. DARU reported that between 2001 and from economic losses occasioned by unsuccessful therapy 2005, 10.7-55.4% of antibiotic medicines failed to meet and worsening illness. The spread of substandard quality specifications. This finding was probably linked to medicines also has political ramifications, undermining the the emergence of resistance against commonly used governments’ investments in health delivery systems and antibiotics during this period. In the year 2000, DARU its credibility with respect to providing quality health care. reported identification of Panadol® junior tablets that contained the wrong ingredient (aspirin instead of Constant surveillance of marketed medicines through paracetamol) and faulty packaging. infrastructure development and capacity building in the country would strengthen quality assurance. For instance, Concerns about high healthcare costs have resulted in imported drugs should routinely be tested on arrival so as tremendous utilization of generic products. According to to ensure that commercially available drugs in the market the United States Food and Drug administration (USFDA), conform with the pharmacopoeial standards. generics should only be marketed if they are bioequivalent Vol. 23, No 4 / Pharmaceutical Journal of Kenya / 2018 112 Amphotericin B toxicities among HIV infected adults with Cryptococcal Meningitis in Kiambu District Hospital A.W. Karita 1 , D.G. Nyamu 1 , P.N. Karimi 1* , S.C. Gitau 2 1University of Nairobi, College of Health Sciences, Department of Pharmaceutics & Pharmacy Practice, P.O Box 19676-00202, Nairobi, Kenya. Emails- P.N. Karimi- [email protected], [email protected], A.W [email protected]. 2Kenyatta University, Department of Pharmacy and complementary/Alternative medicine,
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