Browsing by Author "Maartens, G."

Now showing 1 - 5 of 5
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    Clinical pharmacology becomes a specialty in South Africa
    (2013) Walubo, A.; Barnes, K.; Kwizera, E.; Greeff, O.; Rosenkranz, B.; Maartens, G.
    South Africa recently became the first African country where clinical pharmacology has been approved as a specialty. This article outlines the need for clinical pharmacologists, their role in advancing public health, the potential benefits to the country, and recommendations for ensuring a healthy future for the discipline.
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    Guideline for the management of upper respiratory tract infections
    (Health & Medical Publishing Group, 2004) Brink, A. J.; Cotton, M. F.; Feldman, C.; Geffen, L.; Hendson W.; Hockman, M. H.; Maartens, G.; Madhi, S. A.; Mutua-Mpungu, M.; Swingler G. H.
    Introduction. Inappropriate use of antibiotics for upper respiratory tract infections (URTIs), many of which are viral, adds to the burden of antibiotic resistance. Antibiotic resistance is increasing in Streptococcus pneumoniae, responsible for most cases of acute otitis media (AOM) and acute bacterial sinusitis (ABS). Method. The Infectious Diseases Society of Southern Africa held a multidisciplinary meeting to draw up a national guideline for the management of URTIs. Background information reviewed included randomised controlled trials, existing URTI guidelines and local antibiotic susceptibility patterns. The initial document was drafted at the meeting. Subsequent drafts were circulated to members of the working group for modification. The guideline is a consensus document based upon the opinions of the working group. Output. Penicillin remains the drug of choice for tonsillopharyngitis. Single-dose parenteral administration of benzathine penicillin is effective, but many favour oral administration twice daily for 10 days. Amoxycillin remains the drug of choice for both AOM and ABS. A dose of 90 mg/kg/day is recommended in general, which should be effective for pneumococci with high-level penicillin resistance (this is particularly likely in children ≤ 2 years of age, in day-care attendees, in cases with prior AOM within the past 6 months, and in children who have received antibiotics within the last 3 months). Alternative antibiotic choices are given in the guideline with recommendations for their specific indications. These antibiotics include amoxycillin-clavulanate, some cephalosporins, the macrolide/azalide and ketolide groups of agents and the respiratory fluoroquinolones. Conclusion. The guideline should assist rational antibiotic prescribing for URTIs. However, it should be updated when new information becomes available from randomised controlled trials and surveillance studies of local antibiotic susceptibility patterns.
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    Guidelines for the management of acute meningitis in children and adults in South Africa
    (Taylor & Francis, 2013) Boyles, T. H.; Bamford, C. M.; Bateman, K.; Blumberg, L.; Dramowski, A.; Karstaedt, A.; Korsman, S.; Le Roux, D. M.; Maartens, G.; Madhi, S.; Naidoo, R.; Nuttall, J.; Reubenson, G.; Taljaard, J.; Thomas, J.; Van Zyl, G.; Von Gottberg, A.; Whitelaw, A.; Mendelson, M.
    This guideline provides a rational and cost-effective approach to patients with acute meningitis, which causes considerable morbidity and mortality, predominantly in children.There are many aetiologies, but a small number of bacteria and viruses account for the majority of cases. There should be a low threshold for suspecting acute meningitis, which is a medical emergency and antibiotics should not be delayed. Blood culture and cerebrospinal fluid (CSF) analysis are the most important diagnostic tests and should be performed whenever it is safe and practical. Contraindications to lumbar puncture are discussed and an algorithm is given regarding administering empiric antibiotics and antivirals, performing blood cultures, computer tomography brain scanning and cerebrospinal fluid analysis, depending on the clinical features and availability of resources. Administration of steroids is not recommended. Guidelines are provided for definitive therapy whenever a causative organism is identified. When no organism is identified, treatment and further investigation should be guided by laboratory results and clinical response. An approach to this process is outlined in a second algorithm. The epidemiology of resistance to common pathogens is described and advice given regarding special groups, including those with recurrent meningitis or base-of-skull fractures. Advice regarding infection control, post-exposure prophylaxis and vaccination is provided.
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    Implementing novel regimens for drug-resistant TB in South Africa : what can the world learn?
    (International Union Against Tuberculosis and Lung Disease, 2020-10) Ndjeka, N.; Hughes, J.; Reuter, A.; Conradie, F.; Enwerem, M.; Ferreira, H.; Ismail, N.; Kock, Y.; Master, I.; Meintjes, G.; Padanilam, X.; Romero, R.; Schaaf, H. S.; te Riele, J.; Maartens, G.
    Worldwide uptake of new drugs in the treatment of rifampicin-resistant tuberculosis (RR-TB) has been extremely low. In June 2018, ahead of the release of the updated WHO guidelines for the management of RR-TB, South Africa announced that bedaquiline (BDQ) would be provided to virtually all RR-TB patients on shorter or longer regimens. South Africa has been the global leader in accessing BDQ for patients with RR-TB, who now represent 60% of the global BDQ cohort. The use of BDQ within a shorter modified regimen has generated the programmatic data underpinning the most recent change in WHO guidelines endorsing a shorter, injectable-free regimen. Progressive policies on access to new drugs have resulted in improved favourable outcomes and a reduction in mortality among RR-TB patients in South Africa. This supported global policy change. The strategies underpinning these bold actions include close collaboration between the South African National TB Programme and partners, introduction of new TB diagnostic tools in closely monitored conditions and the use of locally generated programmatic evidence to inform country policy changes. In this paper, we summarise a decade´s work that led to the bold decision to use a modified, short, injectable-free regimen with BDQ and linezolid under carefully monitored programmatic conditions.
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    The mother-to-child HIV transmission debate
    (Health & Medical Publishing Group, 1999) Hussey, G.; Fransman, D.; McGillivray, G.; Reynolds, Lindsey; Jacobs, M.; Power, D.; Burgess, J.; Eley, B.; Woods, D.; Coetzee, N.; Coetzee, E.; Anthony, J.; Maartens, G.; Schaaf, S.; Cotton, M.; Theron, G.
    [No abstract available]