E-DRUG: Antidiarrhoeal Ercefuryl (cont'd)

[Jerome Sclafer <jeromjet@easynet.fr>]

E-drug: Antidiarrhoeal Ercefuryl (cont'd)
---------------------------------------------

On Truls Eriksen's question re Ercefuryl, the product was first
marketed in France. The first approval dates back to 1963 (Dictionnaire
Vidal 1998) and it is presently marketed by Synthelabo. The poor
management of acute diarrhea in France (prescription of ORS is rare)
caused high use of all "antidiarrhoeals". French prescribers have
favoured sulfaguanidine for many years. Promotional activities and the
bad reputation of sulfonamides caused Ercefuryl to gain a large share
of the antidiarrhoeal's market. There are now 4 copies of Ercefuryl on
the French market and two additional ones for export to French
overseas-territories (!).

The paradox with Nifuroxazide is that the claimed indication is bacterial
diarrhea but with a warning that it should not be used in invasive
bacterial diarrhoea. It is therefore reserved for diarrhea for which
there is no evidence of the advantage of any antibacterial drug.
Side-effects do not seem to be a big concern, but it should be
remembered that the products are not marketed in the countries with
the most effective adverse drug reactions surveillance systems.

A 1993 review of Nifuroxazide (revue Prescrire 1993; 13(132):442) stated
that Nifuroxazide has no place in the rational treatment of diarrhoea.
In September 1997, the members of MaLAM (Medical Lobby for
Appropriate Marketing) sent a letter to Smith Kline Beecham, criticizing
a leaflet distributed in Ivory Coast for the promotion of Ambatrol
(Nifuroxazide). The illustration on the leaflet illustrated a possible
action against dehydration and mainly used the slogan of "neutralizing
germs". It even suggested a possible action against shigellosis. To my
knowledge, SKB did not answer MaLAM critics, nor stopped distributing
the leaflet.

Of course, the WHO publication "The Rational Use of Drugs in the
Management of Acute Diarrhoea in Children" is a must, but nifuroxazide
was forgotten, maybe because of poor knowledge of the situation in
French-speaking Africa when it was written.
  
Jerome Sclafer
La revue Prescrire
BP 459 - 75527 France Cedex 11
tel: +33 1 4700 9445
fax: +33 1 4807 8732
e-mail: jeromjet@easynet.fr

[Note from the moderator: Nifuroxazide was not forgotten in the WHO
publication. Instead, a decision was made to concentrate on the "most
commonly used" drugs in the management of acute diarrhoea in
children. That selection did not include Nifuroxazide. Hilbrand Haak]
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