- Email: [email protected]
TOLERANCE OF TWO BRANDS OF PRAZIQUANTEL
391 other patients with PTA and enclosed rt-PA, but in these heparin was given subcutaneously and not intravenously. With respect to Mr Berridge’s question about the duration of femoral occlusion before therapy in patients treated with PTA and enclosed rt-PA, we had examined ankle/brachial and toe/brachial blood pressure indices. These pressures were constant for an average of 4-3 months (range two weeks to 6 months) before arteriography. This finding suggests that the lesions were unchanged for that time. The observation by Mr Berridge that indium- 111 oxime-labelled platelets were undetected after intra-arterial infusion of rt-PA simultaneously with angioplasty is noteworthy and in accordance with our clinical fmdings. Department of Clinical Physiology/ Nuclear Medicine, Bispebjerg Hospital, 2400 København NV, Denmark
K. H. TØNNESEN
TOLERANCE OF TWO BRANDS OF PRAZIQUANTEL
SIR,-Praziquantel has revolutionised
of schistosomiasis since it can be administered as a single, oral dose with only minor side-effects.! Bayer, the German company that discovered the antischistosomal properties of praziquantel, was the first to market this drug (’Biltricide’). However, a Korean company, Shin-Poong Pharmaceutical, has sold their brand (’Distocide’) to the government of Sudan, and both biltricide and distocide are now being used throughout the country. We have studied the efficacy and tolerance of the two brands in villages in the Gezira region of Sudan. A village with a population of 4200 was selected and stool examination was done on 3800 individuals. Those found positive for Schistosoma mansoni infection were assessed quantitatively by a modified Kato technique. 1050 infected individuals who agreed to take part were randomly allocated to biltricide or distocide tablets, which were similar in appearance and were dispensed by a doctor. The patients swallowed the tablets about 30 min after breakfast. The dose was 40 mg/kg body weight. Pregnant women, patients who vomited the drug within half an hour, or those who had had treatment for bilharzia within the previous 6 months were excluded. The remaining 885 patients were followed up. Volunteered side-effects were recorded in the village 2 and 7 days after therapy, by an independent doctor who was blind to the brand administered. Patients were then examined at 6 weeks and 6 months after therapy and stool samples were taken. the
treatment
TABLE I-PARASITOLOGICAL RESPONSE TO TWO BRANDS OF
PRAZIQUANTEL
430 patients received biltricide and 455 patients received distocide. The male to female ratio was almost 1:in both groups, and there were no important group differences in age or weight. The two brands were very similar in effect (table 1). 60% of patients given biltricide but only 40% of those given distocide had one or more side-effects. All side-effects were mild and subsided on the 7th day after therapy. Kardaman and co-workers,2 testing biltricide in the same region of Sudan, noted side-effects in 60% of patients, as we did, and the rates for abdominal pain, vomiting, and diarrhoea were similar too. So the high rate of side-effects we found cannot be explained by observer variation. The most likely explanation for the difference between biltricide and distocide is absorption, and we now plan to study the pharmacokinetics of these two brands. Both brands of praziquantel were effective in reducing infection. We thank Shin-Poong Pharmaceutical Company (Seoul, Korea) for distocide and the technical staff of the Institute for Tropical Diseases for parasitological work. Transportation was provided through the NIH ICIDR grant 16312-09.
Department of Medicine, Faculty of Medicine, PO Box 102, Khartoum, Sudan
MAMOUN M. A. HOMEIDA ISAM A. ELTOM
Bilharzia Research Unit, National Health Laboratories, Khartoum
SUAD M. SULAIMAN
Department of Pharmacy, University of Khartoum
HASSAN M. ALI
Department of Pharmacology and Toxicology, Michigan State University, E. Lansing, Michigan 48823, USA
JAMES L. BENNETT
JL, Depenbusch JW The chemotherapy of schistosomiasis. In: Mansfield JM, ed. Parasitic diseases II. New York Marcel Dekker, 1984: 73-131. Kardaman MW, Amin MA, Fenwick A. A field trial using praziquantel (Biltricide) to treat Schistosoma mansom and S haematobium infection in the Gezira, Sudan. Ann Trop Med Parasitol 1983; 77: 297-304.
1. Bennett 2
CERVICAL SMEARS: A
QUESTIONABLE PRACTICE?
SIR,-Professor McCormick’s critical paper (July 22,
p
207)
debate about virtually every aspect of cervical screening.! However, so that general readers can apply their own caution, his mode of attack needs equally critical comment. Many negative points presented by McCormick are supported by emotive and scientifically unfounded remarks only or by an astutely selected solitary reference, sometimes of great vintage. Some references are cunningly used but overtly wrong since they refer to histopathology encourages
and not
cytology.!
One cannot, in a letter, set out a detailed, referenced counterargument. However, few authorities would now argue with the extensive published evidence that population cervical screening and treatment of severe abnormalities reduce the incidence of and mortality from cervical cancer. The Dundee and Angus 1962-81 results2 and recent European overviews3 are conveniently omitted by McCorn-iick. In our laboratory, cytology rescreening internal quality control indicates a false positive/negative rate of less than 1 %, and even then restricted to minor abnormalities. Cervical cytology quality has had a bad track record. However, unreliability in interpretation and high false positive/negative rates are not now adverse features in most National Health Service laboratories. With the advent of laboratory accreditation and cytology proficiency testing these difficulties will be eliminated. With education and the new Aylesbury spatula many districts are now achieving satisfactory smears in over 95% of women; the fallacy of endocervical cells being the only indicator of adequacy has
recently been highlighted.’ The absence of any weighting of the importance of the points McCormick raises means that the topics of natural history and the significance of "minor abnormalities" are lost in a sea of red herrings. The adverse effects that the blinkered follow-up and treatment of minor abnormalities (persistent inflammatory smears, wart virus, borderline and mild dyskaryosis) are having on the UK *p005.
programme
are not
stressed.
K. H. TØNNESEN
TOLERANCE OF TWO BRANDS OF PRAZIQUANTEL
SIR,-Praziquantel has revolutionised
of schistosomiasis since it can be administered as a single, oral dose with only minor side-effects.! Bayer, the German company that discovered the antischistosomal properties of praziquantel, was the first to market this drug (’Biltricide’). However, a Korean company, Shin-Poong Pharmaceutical, has sold their brand (’Distocide’) to the government of Sudan, and both biltricide and distocide are now being used throughout the country. We have studied the efficacy and tolerance of the two brands in villages in the Gezira region of Sudan. A village with a population of 4200 was selected and stool examination was done on 3800 individuals. Those found positive for Schistosoma mansoni infection were assessed quantitatively by a modified Kato technique. 1050 infected individuals who agreed to take part were randomly allocated to biltricide or distocide tablets, which were similar in appearance and were dispensed by a doctor. The patients swallowed the tablets about 30 min after breakfast. The dose was 40 mg/kg body weight. Pregnant women, patients who vomited the drug within half an hour, or those who had had treatment for bilharzia within the previous 6 months were excluded. The remaining 885 patients were followed up. Volunteered side-effects were recorded in the village 2 and 7 days after therapy, by an independent doctor who was blind to the brand administered. Patients were then examined at 6 weeks and 6 months after therapy and stool samples were taken. the
treatment
TABLE I-PARASITOLOGICAL RESPONSE TO TWO BRANDS OF
PRAZIQUANTEL
430 patients received biltricide and 455 patients received distocide. The male to female ratio was almost 1:in both groups, and there were no important group differences in age or weight. The two brands were very similar in effect (table 1). 60% of patients given biltricide but only 40% of those given distocide had one or more side-effects. All side-effects were mild and subsided on the 7th day after therapy. Kardaman and co-workers,2 testing biltricide in the same region of Sudan, noted side-effects in 60% of patients, as we did, and the rates for abdominal pain, vomiting, and diarrhoea were similar too. So the high rate of side-effects we found cannot be explained by observer variation. The most likely explanation for the difference between biltricide and distocide is absorption, and we now plan to study the pharmacokinetics of these two brands. Both brands of praziquantel were effective in reducing infection. We thank Shin-Poong Pharmaceutical Company (Seoul, Korea) for distocide and the technical staff of the Institute for Tropical Diseases for parasitological work. Transportation was provided through the NIH ICIDR grant 16312-09.
Department of Medicine, Faculty of Medicine, PO Box 102, Khartoum, Sudan
MAMOUN M. A. HOMEIDA ISAM A. ELTOM
Bilharzia Research Unit, National Health Laboratories, Khartoum
SUAD M. SULAIMAN
Department of Pharmacy, University of Khartoum
HASSAN M. ALI
Department of Pharmacology and Toxicology, Michigan State University, E. Lansing, Michigan 48823, USA
JAMES L. BENNETT
JL, Depenbusch JW The chemotherapy of schistosomiasis. In: Mansfield JM, ed. Parasitic diseases II. New York Marcel Dekker, 1984: 73-131. Kardaman MW, Amin MA, Fenwick A. A field trial using praziquantel (Biltricide) to treat Schistosoma mansom and S haematobium infection in the Gezira, Sudan. Ann Trop Med Parasitol 1983; 77: 297-304.
1. Bennett 2
CERVICAL SMEARS: A
QUESTIONABLE PRACTICE?
SIR,-Professor McCormick’s critical paper (July 22,
p
207)
debate about virtually every aspect of cervical screening.! However, so that general readers can apply their own caution, his mode of attack needs equally critical comment. Many negative points presented by McCormick are supported by emotive and scientifically unfounded remarks only or by an astutely selected solitary reference, sometimes of great vintage. Some references are cunningly used but overtly wrong since they refer to histopathology encourages
and not
cytology.!
One cannot, in a letter, set out a detailed, referenced counterargument. However, few authorities would now argue with the extensive published evidence that population cervical screening and treatment of severe abnormalities reduce the incidence of and mortality from cervical cancer. The Dundee and Angus 1962-81 results2 and recent European overviews3 are conveniently omitted by McCorn-iick. In our laboratory, cytology rescreening internal quality control indicates a false positive/negative rate of less than 1 %, and even then restricted to minor abnormalities. Cervical cytology quality has had a bad track record. However, unreliability in interpretation and high false positive/negative rates are not now adverse features in most National Health Service laboratories. With the advent of laboratory accreditation and cytology proficiency testing these difficulties will be eliminated. With education and the new Aylesbury spatula many districts are now achieving satisfactory smears in over 95% of women; the fallacy of endocervical cells being the only indicator of adequacy has
recently been highlighted.’ The absence of any weighting of the importance of the points McCormick raises means that the topics of natural history and the significance of "minor abnormalities" are lost in a sea of red herrings. The adverse effects that the blinkered follow-up and treatment of minor abnormalities (persistent inflammatory smears, wart virus, borderline and mild dyskaryosis) are having on the UK *p005.
programme
are not
stressed.