Assuntos
Antimaláricos/provisão & distribuição , Antimaláricos/uso terapêutico , Malária Falciparum/tratamento farmacológico , Quinidina/análogos & derivados , Artesunato/uso terapêutico , Aprovação de Drogas , Humanos , Malária Falciparum/diagnóstico , Masculino , Planejamento de Assistência ao Paciente , Quinidina/provisão & distribuição , Quinidina/uso terapêutico , Índice de Gravidade de Doença , Estados Unidos , United States Food and Drug Administration , Adulto JovemRESUMO
OBJECTIVES: The aim of this study was to determine the availability of quinidine throughout the world. BACKGROUND: Quinidine is the only oral medication that is effective for preventing life-threatening ventricular arrhythmias due to Brugada syndrome and idiopathic ventricular fibrillation. However, because of its low price and restricted indication, this medication is not marketed in many countries. METHODS: We conducted a survey of the availability of quinidine by contacting professional medical societies and arrhythmia specialists worldwide. Physicians were e-mailed questionnaires requesting information concerning the quinidine preparation available at their hospital. We also requested information concerning cases of adverse arrhythmic events resulting from unavailability of quinidine. RESULTS: A total of 273 physicians from 131 countries provided information regarding the availability of quinidine. Quinidine was readily available in 19 countries (14%), not accessible in 99 countries (76%), and available only through specific regulatory processes that require 4 to 90 days for completion in 13 countries (10%). We were able to gather information concerning 22 patients who had serious arrhythmias probably related (10 cases) or possibility related (12 cases) to the absence of quinidine, including 2 fatalities possibly attributable to the unavailability of quinidine. CONCLUSIONS: The lack of accessibility of quinidine is a serious medical hazard at the global level.
Assuntos
Síndrome de Brugada/tratamento farmacológico , Saúde Global , Acessibilidade aos Serviços de Saúde , Quinidina/provisão & distribuição , Quinidina/uso terapêutico , Fibrilação Ventricular/tratamento farmacológico , Antiarrítmicos/provisão & distribuição , Antiarrítmicos/uso terapêutico , Síndrome de Brugada/complicações , Síndrome de Brugada/diagnóstico , Estudos Transversais , Uso de Medicamentos , Feminino , Humanos , Masculino , Avaliação das Necessidades , Medição de Risco , Inquéritos e Questionários , Análise de Sobrevida , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/mortalidadeAssuntos
Antiarrítmicos/uso terapêutico , Síndrome de Brugada/tratamento farmacológico , Recall e Retirada de Produto , Quinidina/uso terapêutico , Antiarrítmicos/provisão & distribuição , Indústria Farmacêutica/estatística & dados numéricos , Humanos , Quinidina/provisão & distribuição , Estados UnidosRESUMO
Since 1991, quinidine gluconate, a class 1a anti-arrhythmic agent, has been the only parenteral antimalarial available for use in the United States (1). It is indicated for the treatment of patients with life-threatening Plasmodium falciparum malaria (2), including those who cannot tolerate oral therapy, have high-grade parasitemia, or have complications (e.g., cerebral malaria or acute renal failure).