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N M Amin

Publications and source records attributed to N M Amin.

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Prophylaxis for malaria. Helping world travelers come home healthy.

Malaria is largely preventable, so travelers should be taught general protective measures and given appropriate chemoprophylaxis before they leave on their trip. Chloroquine phosphate (Aralen) is still the drug of choice in locations where malaria remains chloroquine-sensitive. However, chloroquine-resistant areas infested with Plasmodium falciparum are becoming more numerous. In such areas, mefloquine hydrochloride (Lariam), doxycycline, or proguanil (Paludrine) (obtainable outside the United States) may be used. A single dose of pyrimethamine-sulfadoxine (Fansidar) may be used to treat presumptive malarial infection if medical care is not immediately available. For prevention of relapse of Plasmodium vivax and Plasmodium ovale infection, primaquine phosphate is recommended for the final 2 weeks of chemoprophylaxis on return from a malarious area.

Antimalarials

Let's stop the comeback of tuberculosis. Best drug regimens for prevention and treatment.

Tuberculosis has been on the increase in recent years, so physicians need to be aware of it once again. Very effective drugs are available to treat the disease. Pharmacokinetics, dosing schedule, and adverse reactions of each anti-tuberculous agent need to be considered. A short (6-month) course of therapy is now recommended: Isoniazid, rifampin (Rifadin, Rimactane), and pyrazinamide are given for the initial 2 months, followed by isoniazid and rifampin for 4 months. If drug resistance is a factor, a fourth drug is added to the initial regimen, and therapy may have to be extended. Chemoprophylaxis with isoniazid is very important to reduce the incidence of tuberculosis. It should be given to all high-risk persons.

Antitubercular Agents

Zidovudine for treating AIDS. What physicians need to know.

Zidovudine (Retrovir) is the only drug found to be useful for managing human immunodeficiency virus (HIV) infection in patients with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex. The drug is virostatic, ie, it prevents replication of HIV by inhibiting the enzyme reverse transcriptase. Zidovudine is well tolerated and provides short-term benefits by improving the quality of life and extending survival time. It is expensive and can be toxic, however, so its use requires close supervision. Zidovudine at present is approved only for patients with documented Pneumocystis carinii pneumonia or with a CD4 count below 200/mm3. Other probable indications include HIV wasting syndrome, HIV dementia complex, oral candidiasis, Kaposi's sarcoma, the presence of early markers of HIV infection, and HIV-related symptomatic thrombocytopenia. A stepwise approach to initiating zidovudine therapy should include detailed counseling and close surveillance.

Acquired Immunodeficiency Syndrome

Malaria--a red alert.

Imported malaria has been increasing in the United States. Locally acquired cases are reported in drug addicts. Extended incubation periods can be misleading. Pyrexia is the most common manifestation, but it may not follow a regular pattern. A high index of suspicion and examination of peripheral blood smears establish the diagnosis. Chloroquine and primaquine are the drugs of choice for uncomplicated malaria; quinine sulfate is preferred in the treatment of chloroquine-resistant malaria. Malarial prophylaxis should include travelers' education and chemoprophylactic agents such as chloroquine, chloroguanide, pyrimethamine and amodiaquine.

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