Az aminokinolinok egy régóta használt gyógyszercsoport, amely napjainkban is elengedhetetlen számos kórkép, különösen szisztémás gyulladásos kórképek terápiájában. Az éles látásért felelős retinarész, a macula klorokin és hidroxiklorokin által okozott toxikus károsodása már jól ismert mellékhatás volt a múlt században is. Az ilyen gyógyszert hosszú távon szedő krónikus betegek szemészeti szűrése azóta visszatérő kérdéskör, mely az újonnan megjelenő evidenciák által folyamatosan megújuló vizsgálati protokollokban nyilvánul meg. Tanulmányunkban áttekintjük a jelenleg érvényes nemzetközi irányelveket, kitérve arra, hogy az ezekben újonnan történő változtatások milyen új adatokon alapszanak. Ismertetjük a korszerű szemészeti szűrés műszereit (automata látótérvizsgálat, optikaikoherencia-tomográfia [OCT], fundus-autofluoreszcencia [FAF], multifokális elektroretinográfia [mfERG]), valamint a klorokint vagy hidroxiklorokint szedő betegeknél azonosított rizikófaktorokat, melyek hajlamosítanak a maculopathia kialakulására. Végezetül egy hazai viszonyokra adaptált szűrési protokollt szeretnénk bemutatni. Orv Hetil. 2024; 165(30) 1147–1153.

BACKGROUND: In early 2020, the coronavirus disease 2019 (COVID-19) pandemic spread worldwide, overwhelming hospitals with severely ill patients and posing the urgent need for clinical evidence to guide patient care. First treatment options available were repurposed drugs to fight inflammation, coagulopathy, and viral replication. A vast number of clinical studies were launched globally to test their efficacy and safety. Our analysis describes the development of global evidence on repurposed drugs, in particular corticosteroids, anticoagulants, and (hydroxy)chloroquine in hospitalized COVID-19 patients based on different study types. We track the incorporation of clinical data in international and national treatment guidelines and identify factors that characterize studies and analyses with the greatest impact on treatment recommendations.
METHODS: A literature search in MEDLINE was conducted to assess the clinical evidence on treatment with corticosteroids, anticoagulants, and (hydroxy)chloroquine in hospitalized COVID-19 patients during the first year of the pandemic. Adoption of the evidence from this clinical data in treatment guidelines of the World Health Organization (WHO), Germany, and United States (US) was evaluated over time.
RESULTS: We identified 106 studies on corticosteroids, 141 studies on anticoagulants, and 115 studies on (hydroxy)chloroquine. Most studies were retrospective cohort studies; some were randomized clinical trials (RCTs), and a few were platform trials. These studies were compared to studies directly and indirectly referred to in WHO (7 versions), German (5 versions), and US (21 versions) guidelines. We found that initially large, well-adjusted, mainly retrospective cohort studies and ultimately large platform trials or coordinated meta-analyses of RCTs provided best available clinical evidence supporting treatment recommendations.
CONCLUSIONS: Particularly early in the pandemic, evidence for the efficacy and safety of repurposed drugs was of low quality, since time and scientific rigor seemed to be competing factors. Pandemic preparedness, coordinated efforts, and combined analyses were crucial to generating timely and robust clinical evidence that informed national and international treatment guidelines on corticosteroids, anticoagulants, and (hydroxy)chloroquine. Multi-arm platform trials with master protocols and coordinated meta-analyses proved particularly successful, with researchers joining forces to answer the most pressing questions as quickly as possible.

Since the outbreak of COVID-19, and its declaration as a pandemic by the World Health Organization (WHO), the reliance on pharmacists as one of the first points of contact within the healthcare system has been highlighted. This evidence-based review is aimed at providing guidance for pharmacists in community, hospital and other settings in South Africa, on the management of patients with suspected or confirmed coronavirus disease 2019, or COVID-19. The situation is rapidly evolving, and new evidence continues to emerge on a daily basis. This guidance document takes into account and includes newly available evidence and recommendations, particularly around the following aspects relating to COVID-19: EpidemiologyThe virus, its modes of transmission and incubation periodSymptom identification, including the differentiation between influenza, allergic rhinitis, sinusitis and COVID-19Social media myths and misinformationTreatment guidelines and medicines that may need to be kept in stockTreatment and prevention options, including an update on vaccine developmentThe case for and against the use of NSAIDs, ACE-inhibitors and angiotensin receptor blockers (ARBs) in patients with COVID-19Interventions and patient counselling by the pharmacist. It is critical, though, that pharmacists access the most recent and authoritative information to guide their practice. Key websites that can be relied upon are: World Health Organization (WHO): https://www.who.int/emergencies/diseases/novel-coronavirus-2019National Institute for Communicable Diseases (NICD): https://www.nicd.ac.za/diseases-a-z-index/covid-19/National Department of Health (NDoH): http://www.health.gov.za/index.php/outbreaks/145-corona-virus-outbreak/465-corona-virus-outbreak; https://sacoronavirus.co.za/.

BACKGROUND: Malaria caused by Plasmodium falciparum in pregnancy can result in adverse maternal and fetal sequelae. This review evaluated the adherence of the national guidelines drawn from World Health Organization (WHO) regions, Africa, Eastern Mediterranean, Southeast Asia, and Western Pacific, to the WHO recommendations on drug treatment and prevention of chloroquine-resistant falciparum malaria in pregnant women.
METHODS: Thirty-five updated national guidelines and the President\'s Malaria Initiative (PMI), available in English language, were reviewed. The primary outcome measures were the first-line anti-malarial treatment protocols adopted by national guidelines for uncomplicated and complicated falciparum malaria infections in early (first) and late (second and third) trimesters of pregnancy. The strategy of intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) was also addressed.
RESULTS: This review evaluated the treatment and prevention of falciparum malaria in pregnancy in 35 national guidelines/PMI-Malaria Operational Plans (MOP) reports out of 95 malaria-endemic countries. Of the 35 national guidelines, 10 (28.6%) recommend oral quinine plus clindamycin as first-line treatment for uncomplicated malaria in the first trimester. As the first-line option, artemether-lumefantrine, an artemisinin-based combination therapy, is adopted by 26 (74.3%) of the guidelines for treating uncomplicated or complicated malaria in the second and third trimesters. Intravenous artesunate is approved by 18 (51.4%) and 31 (88.6%) guidelines for treating complicated malaria during early and late pregnancy, respectively. Of the 23 national guidelines that recommend IPTp-SP strategy, 8 (34.8%) are not explicit about directly observed therapy requirements, and three-quarters, 17 (73.9%), do not specify contra-indication of SP in human immunodeficiency virus (HIV)-infected pregnant women receiving cotrimoxazole prophylaxis. Most of the guidelines (18/23; 78.3%) state the recommended folic acid dose.
CONCLUSIONS: Several national guidelines and PMI reports require update revisions to harmonize with international guidelines and emergent trends in managing falciparum malaria in pregnancy. National guidelines and those of donor agencies should comply with those of WHO guideline recommendations although local conditions and delayed guideline updates may call for deviations from WHO evidence-based guidelines.

The coronavirus disease (COVID-19) pandemic has led to a global struggle to cope with the sheer numbers of infected persons, many of whom require intensive care support or eventually succumb to the illness. The outbreak is managed by a combination of disease containment via public health measures and supportive care for those who are affected. To date, there is no specific anti-COVID-19 treatment. However, the urgency to identify treatments that could turn the tide has led to the emergence of several investigational drugs as potential candidates to improve outcome, especially in the severe to critically ill. While many of these adjunctive drugs are being investigated in clinical trials, professional bodies have attempted to clarify the setting where the use of these drugs may be considered as off-label or compassionate use. This review summarizes the clinical evidence of investigational adjunctive treatments used in COVID-19 patients as well as the recommendations of their use from guidelines issued by international and national organizations in healthcare.

At the end of December 2019, a novel coronavirus (COVID-19) caused an outbreak in Wuhan, and has quickly spread to all provinces in China and 26 other countries around the world, leading to a serious situation for epidemic prevention. So far, there is still no specific medicine. Previous studies have shown that chloroquine phosphate (chloroquine) had a wide range of antiviral effects, including anti-coronavirus. Here we found that treating the patients diagnosed as novel coronavirus pneumonia with chloroquine might improve the success rate of treatment, shorten hospital stay and improve patient outcome. In order to guide and regulate the use of chloroquine in patients with novel coronavirus pneumonia, the multicenter collaboration group of Department of Science and Technology of Guangdong Province and Health Commission of Guangdong Province for chloroquine in the treatment of novel coronavirus pneumonia developed this expert consensus after extensive discussion. It recommended chloroquine phosphate tablet, 500mg twice per day for 10 days for patients diagnosed as mild, moderate and severe cases of novel coronavirus pneumonia and without contraindications to chloroquine.
自2019年12月，武汉暴发了一种新型冠状病毒（COVID-19）感染，迅速蔓延至我国各省市及全球26个国家，防疫形势十分严峻。但是目前尚无特效药物。磷酸氯喹（简称氯喹）具有广泛抗病毒及抗冠状病毒的作用，临床研究结果显示氯喹或可提高新型冠状病毒肺炎患者的救治成功率、缩短住院时间及改善预后。为指引并规范氯喹在新型冠状病毒肺炎中的使用，广东省科技厅、广东省卫生健康委氯喹治疗新冠状病毒肺炎多中心协作组经充分讨论后，制定本专家共识,对确诊为新型冠状病毒肺炎轻型、普通型和重型患者，排除氯喹禁忌证后，可以使用磷酸氯喹片每次500 mg，2次/d，疗程10 d。.

At the end of December 2019, a novel coronavirus (COVID-19) caused an outbreak in Wuhan, and has quickly spread to all provinces in China and 26 other countries around the world, leading to a serious situation for epidemic prevention. So far, there is still no specific medicine. Previous studies have shown that chloroquine phosphate (chloroquine) had a wide range of antiviral effects, including anti-coronavirus. Here we found that treating the patients diagnosed as novel coronavirus pneumonia with chloroquine might improve the success rate of treatment, shorten hospital stay and improve patient outcome. In order to guide and regulate the use of chloroquine in patients with novel coronavirus pneumonia, the multicenter collaboration group of Department of Science and Technology of Guangdong Province and Health Commission of Guangdong Province for chloroquine in the treatment of novel coronavirus pneumonia developed this expert consensus after extensive discussion. It recommended chloroquine phosphate tablet, 500mg twice per day for 10 days for patients diagnosed as mild, moderate and severe cases of novel coronavirus pneumonia and without contraindications to chloroquine.
自2019年12月，武汉暴发了一种新型冠状病毒病（COVID-19），迅速蔓延至我国各省市及全球26个国家，防疫情势十分严峻。但是目前尚无特效药物。磷酸氯喹（简称氯喹）具有广泛抗病毒及抗冠状病毒的作用，临床研究结果显示氯喹或可提高新型冠状病毒肺炎患者的救治成功率、缩短住院时间及改善预后。为指引并规范氯喹在新型冠状病毒肺炎中的使用，广东省科技厅、广东省卫生健康委氯喹治疗新冠状病毒肺炎多中心协作组经充分讨论后，制定本专家共识,对确诊为新型冠状病毒肺炎轻型、普通型和重型患者，排除氯喹禁忌证后，可以使用磷酸氯喹片每次500 mg，2次/d，疗程10 d。.

BACKGROUND: Chloroquine resistance (CR) decreased after the removal of chloroquine from national treatment guidelines in Malawi, Kenia and Tanzania. In this investigation the prevalence of the chloroquine resistance (CQR) conferring mutant pfcrt allele and its associated chromosomal haplotype were determined before and after the change in Gabonese national treatment guidelines from chloroquine (CQ) to artesunate plus amodiaquine (AQ) in 2003.
METHODS: The prevalence of the wild type pfcrt allele was assessed in 144 isolates from the years 2005 - 07 by PCR fragment restriction digest and direct sequencing. For haplotype analysis of the chromosomal regions flanking the pfcrt locus, microsatellite analysis was done on a total of 145 isolates obtained in 1995/96 (43 isolates), 2002 (47 isolates) and 2005 - 07 (55 isolates).
RESULTS: The prevalence of the mutant pfcrt allele decreased from 100% in the years 1995/96 and 2002 to 97% in 2005 - 07. Haplotype analysis showed that in 1995/96 79% of the isolates carried the same microsatellite alleles in a chromosomal fragment spanning 39 kb surrounding the pfcrt locus. In 2002 and 2005 - 07 the prevalence of this haplotype was 62% and 58%, respectively. Pfcrt haplotype analysis showed that all wild type alleles were CVMNK.
CONCLUSIONS: Four years after the withdrawal of CQ from national treatment guidelines the prevalence of the mutant pfcrt allele remains at 97%. The data suggest that the combination of artesunate plus AQ may result in continued selection for the mutant pfcrt haplotype even after discontinuance of CQ usage.

OBJECTIVE: To describe the development of a treatment guideline for the effective case management of malaria in children at the home level.
METHODS: Thirty-three mothers selected from 11 communities in a rural health district, community members and the research team developed a guideline for treatment of malaria at home by caregivers using a participatory approach. This was done in phases using modified focus group discussion sessions. Suggested ideas were depicted in illustrations by a graphic artist.
RESULTS: A guideline which illustrated the presentation of clinical types of malaria, the appropriate steps to take for each type and the correct dosage schedule of chloroquine (based on the age of the child) for treatment of uncomplicated malaria was developed. The guideline was in cartoon format and the script in the local language.
CONCLUSIONS: Use of a participatory approach was found acceptable and effective in the development of the guideline. This approach is therefore recommended irrespective of the target population or the intervention to be developed. Practice implications Preparation of educational materials with contributions from end users does not only build capacity at the local level but also increases the acceptability and ownership of such materials.

OBJECTIVE: To assess the knowledge of dispensers in private pharmacies on new malaria treatment guidelines which involved switching from chloroquine (CQ) to sulfadoxine pyrimethamine (SP) and from SP to artemether-lumefantrine.
METHODS: A structured questionnaire was used for data collection and the questions focused on whether the subjects were involved in the preparation or implementation of the guidelines or had undertaken any training on how to dispense new antimalarial medicines as recommended in the introduced new treatment guidelines.
RESULTS: The study revealed that none of the participants had been involved in the preparation of the treatment guidelines, nor had they undertaken any training on their implementation. As many as 49% of the visited private pharmacies were found to continue stocking and selling CQ tablets and injections. Only 30% and 7% knew the correct dose regimen of SP and ALU respectively and none of them knew the condition of taking ALU with a fatty meal for improved absorption.
CONCLUSIONS: Lack of involvement of the pharmaceutical personnel working in the private pharmacies, from the preparation of new malaria treatment guidelines to their implementation, contributed to their poor knowledge and skill on how to correctly dispense the medicines.