title: Community management of anti-malarials in Africa and iatrogenic risk.
abstract: Distribution of anti-malarials at the community level is one of the interventions recommended to reduce mortality from febrile illnesses. Inappropriate treatment of fever with anti-malarials may result in missed diagnosis and delays in appropriate treatments including consideration of other illnesses than malaria. We report the case of an 8-year-old black girl receiving prophylaxis with sulfadoxine-pyrimethamine from the caretaker of the community during her holidays in Ivory Coast. A persistent fever suspected to be due to malaria was treated inappropriately with atovaquone-proguanil and then with sulfadoxine-pyrimethamine again. Cumulative toxicity of anti-malarials leads to irreversible hepatic damages requiring hepatic transplantation. Community caretakers must be aware of the potential side effects and the contraindications of anti-malarials. Early identification of drug-induced toxicity and immediate discontinuation of the drug are the more effective tools to limit the progression of tissue damage.
authors.affiliation: Service de Pharmacologie, Hôpital de Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: Lupé
authors.initials: L
authors.lastname: Orostegui
authors.forename: Laurent
authors.initials: L
authors.lastname: Balu
authors.forename: Laurent
authors.initials: L
authors.lastname: Chevret
authors.forename: Dalila
authors.initials: D
authors.lastname: Habes
authors.forename: Eric
authors.initials: E
authors.lastname: Pussard
mesh_terms: D000962:Antimalarials / Q000009:adverse effects*; D053626:Atovaquone / Q000009:adverse effects*; D002648:Child; D003153:Community Health Services; D000075202:Contraindications; D007560:Cote d'Ivoire; D003951:Diagnostic Errors / Q000009:adverse effects*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000175:diagnosis; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy; D002727:Proguanil / Q000009:adverse effects*; D011739:Pyrimethamine / Q000009:adverse effects*; D013413:Sulfadoxine / Q000009:adverse effects*
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C109496:atovaquone, proguanil drug combination; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002727:Proguanil; D053626:Atovaquone; D011739:Pyrimethamine