Routine prophylactic antibiotic use in the management of snakebite

BACKGROUND: Routine antibiotic prophylaxis following snakebite is not recommended but evidence suggests that it may be common practice in Zimbabwe. This study set out to determine and describe the extent of this practice at Parirenyatwa Hospital, a large teaching hospital in Zimbabwe METHODS: A retrospective case review (1996 to 1999 inclusive) of all cases of snakebite was undertaken at Parirenyatwa Hospital. Cases with a diagnosis of snakebite, presenting within 24 hours of the bite and with no complications or concurrent illness were defined as "routine prophylactic antibiotic use". RESULTS: From 78 cases which satisfied the inclusion criteria, 69 (88.5%) received antibiotics. Ten different antibiotics from 6 different classes were used with penicillins the most commonly prescribed (benzylpenicillin in 29% of cases, alone or in combination). Over 40% of antibiotics were given parenterally although all patients were conscious on admission. The total cost of antibiotics used was estimated at US$522.98. CONCLUSION: Routine prophylactic use of antibiotics in snakebite at Parirenyatwa Hospital is common practice. This may highlight the lack of a clearly defined policy leading to wasteful inappropriate antibiotic use which is costly and may promote bacterial antibiotic resistance. Further work is required to investigate the reasons for this practice and to design appropriate interventions to counter it

Health education for the practitioner

Pharmacogenomics: today, tommorrow and beyon

A simple qualitive procedure for the detection of chloroquine in urine for use in clinical analytical toxicology in resource poor settings

Objective: To develop and validate a simple procedure for the qualitative determination of chloroquine in urine with potential for use in developing countries lacking sophisticated analytical equipment and expensive reagents.Design: This was a laboratory based study making use of which combines a colorimetric test, Dill-Glazko's test, and UV/Visible absorbance spectrometry to confirm the presence of chloroquine. The spectrophotometric method was cross validated with the standard Baselt's method for quantification of chloroquine in biological fluids.Setting: Pharmacology laboratory at the Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe.Main Outcome Measures: Recovery of the methods was assessed by comparing the peak absorbances and the resolution of the peaks at 329nm and 343nm. Sensitivity and specificity was determined by analysing in a blinded manner. The limits of detection of both the Dill-Glazko's test and the confirmatory test was determined.Results: In the prevalidation procedures increasing the volume of the ethylacetate and the volume of the lower aqueous layer extracted was found to increase the recovery of the confirmatory test. There was a significant difference between both the peak absorbances and the peak resolution for the two methods (p<0.0001). The confirmatory test had a sensitivity of 90% and a specificity of 100%, whereas the Baselt's method had a sensitivity of 83.3% and a specificity of 96.7%. The limit of detection of the Dill-Glazko's test was 15mg/Land that of the confirmatory test was 5mg/L.Conclusions: The confirmatory test had better recovery and was more sensitivity compared with the Baselt's method. The limit of detection of the combination method (Dill-Glazko's plus confirmatory test) was 15mg/L. The combination test showed appreciable sensitivity to be suitable for application to clinicaltoxicology

Factors influencing treatment failure in HIV positive adult patients on first line antiretroviral therapy

Background: Risk factors for treatment failure in HIV positive adults have not been studied extensively in Zimbabwe.  Aim: To investigate socio-demographic, psychosocial and antiretroviral drug related factors as possible risk factors for treatment failure. Objective: To compare the accuracy and reliability of CD4 count results in diagnosing treatment failure versus viral load results. Design: A descriptive cross-sectional survey. Setting: Harare Central Hospital adult opportunistic infections clinic. Participants: One hundred and eighteen (118) HIV positive participants on 1st line antiretroviral therapy (any 1 of stavudine, tenofovir or zidovudine combined with lamivudine and nevirapine or efavirenz) for at least 1 year. Participants were conveniently sampled.Main Outcome Measures: First line treatment failure as defined according to World Health Organisation (WHO) 2010 guidelines.Results: Factors associated with higher odds of treatment failure were severe depression [OR 3.7; p-value 0.002; 95% CI 1.6-8.5] and discontinuing ART [OR 4.4; p-value 0.02; 95% CI 1.3-14.7]. Factors associated with lower odds of treatment failure were age ≥42 [OR 0.3; p-value 0.007; 95% CI 0.1-0.7], taking ART on time [OR 0.2; p-value 0.02; 95% CI 0.05-0.8], time on ART >4 years [OR 0.6; p-value 0.02; 95% CI 0.3-0.9] and female sex [OR 0.4; p-value 0.02; 95% CI 0.2-0.8]. There was statistically significant difference between CD4 count and viral load results in diagnosing treatment failure [OR 8.7; p-value 0.0005; 95% CI 3.6-21.2].Conclusion: Severe depression and discontinuing ART predisposed to treatment failure. CD4 counts were not as reliable as viral load measurements in diagnosing treatment failur

Factors influencing treatment failure in HIV positive adult patients on first line antiretroviral therapy

Background: Risk factors for treatment failure in HIV positive adults have not been studied extensively in Zimbabwe.Aim: To investigate socio-demographic, psychosocial and antiretroviral drug related factors as possible risk factors for treatment failure.Objective: To compare the accuracy and reliability of CD4 count results in diagnosing treatment failure versus viral load results.Design: A descriptive cross-sectional survey.Setting: Harare Central Hospital adult opportunistic infections clinic.Participants: One hundred and eighteen (118) HIV positive participants on 1st line antiretroviral therapy (any 1 of stavudine, tenofovir or zidovudine combined with lamivudine and nevirapine or efavirenz) for at least 1 year. Participants were conveniently sampled.Main Outcome Measures: First line treatment failure as defined according to World Health Organisation (WHO) 2010 guidelines.Results: Factors associated with higher odds of treatment failure were severe depression [OR 3.7; p-value 0.002; 95% Cl 1.6-8.5] and discontinuing ART [OR 4.4; p-value 0.02; 95% Cl 1.3-14.7]. Factors associated with lower odds of treatment failure were age >42 [OR 0.3; p-value 0.007; 95% Cl 0.1-0.7], taking ART on time [OR 0.2; p-value 0.02; 95% Cl 0.05-0.8], time on ART >4 years [OR 0.6; p-value 0.02; 95% Cl 0.3-0.9] and female sex [OR 0.4; p-value 0.02; 95% Cl 0.2-0.8]. There was statistically significant difference between CD4 count and viral load results in diagnosing treatment failure [OR 8.7; p-value 0.0005; 95% Cl 3.6-21.2], Conclusion: Severe depression and discontinuing ART predisposed to treatment failure. CD4 counts were not as reliable as viral load measurements in diagnosing treatment failure

Use of cotrimoxazole prophylaxis in HIV infected patients at a referral hospital

No Abstrac

Organophosphate and organochlorine exposure in selected horticultural farms in Zimbabwe

The epidemiology of pesticide use and pesticide exposure in the farming communities has been researched on and documented. The results from these studies, conducted in all sectors of agriculture except horticulture show high levels of occupational exposure. We present a pilot study conducted in two horticultural farms in Ruwa and Domboshawa 25 kilometres and 30 kilometres from Harare respectively in 2001.The main objective was to establish the level and prevalence of pesticide exposure in workers in the horticultural industry. Blood samples were collected from 33 workers from the two farms. Cholinesterase activity was measured using the WHO cholinesterase kit and organochlorine residues were analysed using the GC method. Organochlorine residues were detected in the following order of frequency, pp-DDT, 100%; op-DDT, 100%; aldrin, 95%; a-HCH, 100%; dieldrin, 86.4%; heptachlor, 22.7% and opDDD, 18.2% from the blood samples analysed. The ppDDT isomer was the major contributing isomer to the sumDDT. The two isomers a- and ß-HCH were also detected in the samples analysed and the former being the major contributing isomer to the sum-HCH. In Ruwa the exposed subjects had higher DDT blood levels than the control group though this was not statistically significant (p=0.1855). There was also no significant difference in the mean DDE levels of the exposed group and the control group (p=0.6851). Significant differences were however noted in the mean blood levels of a-HCH (p=0.007) and aldrin (p=0.0187). In Domboshawa there were no significant differences in the mean blood levels of organochloride residues between the exposed and the control. No significant depression of the cholinesterase activity was observed. The results demonstrated a high level of pollution of human blood with organochlorine residues. The pollution was due to both occupational and environmental exposure. Keywords: Organochlorine, pesticide exposure, horticultur