Important note: Information in this article was accurate in 2005. The state of the art may have changed since the publication date.
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New Vision (Kampala) December 7, 2005
Timothy Makokha and Hilary Bainemigisha
The director of clinical services at Mildmay Centre, Dr Emmanuel Luyirika, says Septrin prevents common HIV-related illnesses and opportunistic infections of the chest, diarrhoea and malaria.
"However, it is not an alternative to ARVs (anti-retroviral treatment) but a complementary treatment," he said.
At Mildmay Centre in Lweza on Entebbe Road, all PLWHA, from six weeks old are given one Septrin a day in addition to ARVs.
According to the Ministry of Health publication, Guidelines to Clinical Treatment of HIV in Uganda, it is Government policy that all PLWHA be given septrin prophylaxis.
Prophylaxis means prevention of or protective treatment against disease. It is treatment given when patients are not suffering from the ailment to fortify them from the disease.
"Even in situations of body resistance, Septrin must still be given because it covers several micro-organisms", Luyirika added.
Ordinarily, Septrin, a brand name for a combination of antibiotics called cotrimoxazole, is an anti-bacterial product meant for infections like upper respiratory tract infection, middle ear infection, urinary tract infection, gonorrhoea and traveller's diarrhoea.
Dr. Emmanuel Bahizi of Kololo Hospital calls Septrin a saviour for PLWHA, who are at a greater risk of developing pneumocystis carinii pneumonia (PCP).
He says PCP is an opportunistic infection that occurs in immune-suppressed populations. It usually comes off with dry cough, progressive shortness of breath and fever. PCP is a potentially fatal illness, which used to be the leading cause of death for people with HIV/AIDS.
"Septrin reduces the risk of pneumonia and is responsible for the now less common PCP," he said.
Luyirika says a Septrin dose should be given according to weight. There is syrup especially for children and tablet of 480mg and 960mg.
In some cases an intravenous form is used.
Bahizi said the most common dose for prophylaxis for PLWHA is one double strength (960mg) tablet everyday. An alternative dose is one tablet three times a week.
The 960mg Septrin costs between sh100 and sh200 per tablet and a monthly dose costs between sh3,000 and sh6,000.
The World Health Organisation has also recommended that children with HIV/AIDS in developing countries should get Septrin daily after a research in Zambia found that Septrin almost halved the risk of death among children.
One paediatrician at Mulago Hospital says children born to HIV positive mothers should be started on Septrin as a preventive therapy at six weeks of age and only stopped if proven to be HIV negative at 18 months.
Side-effects
Prescription forms that come with Septrin say that some people can be allergic to it and develop reactions such as an itchy red rash, sometimes with fever.
According to the ministry guidelines to clinical treatment of HIV, the allergies usually occur during the second week of taking the drug. In rare cases, the reactions are extremely serious, so they should be reported to a doctor at once.
The publication talks of anaemia as the most common side effect experienced at the higher doses used for treating PCP It can also affect people using Septrin for prophylaxis. Some people experience a shortage of white blood cells.
There may also be cases of liver problems. Blood tests can monitor both your blood cell levels and your liver function.
People with kidney damage may need to take lower doses.
Other effects include reduced levels of folate, a B vitamin that is essential for cell growth and reproduction. Therefore, you should not take Septrin without a doctor's prescription.
But because Septrin is the best form of prophylaxis, the Ministry of Health advises doctors to try to overcome any allergic reactions. They may suggest trying again a few weeks later, as it is not always clear whether an allergy is due to Septrin or to other drugs.
Alternatively, doctors may overcome the allergy by starting again at a very small dose and gradually increasing it to the normal level, a process called desensitisation. Many people who have an initial reaction to Septrin can be desensitised under the supervision of a doctor.
Who should not use it
* People who should not use Septrin include:
* Those whose allergy to Septrin components cannot be controlled. Septrin has components of trimethoprim and sulphonamides and people with allergy to sulphur may find it difficult.
* Infants less than six weeks old.
* Those with gastrointestinal disturbances
* Where Septrin produces a blood components reaction.
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