10 Malaria, part 2

Question 1

Drug of choice for uncomplicated (nonsevere) malaria due to P falciparum

Answer 1

Artemisinin-containing combination therapies
- Artemether-lumefantrine
- Artesunate-amodiaquine

For 3 days

Question 2

Alternatives in uncomplicated (nonsevere) malaria due to P falciparum

Answer 2

Atovaquone-proguanil
or
Quinine sulfate + doxycyline or clindamycin (if <8y)

For 3-7 days

Question 3

Treatment of nonfalciparum malaria

Answer 3

Chloroquine
alternative: artemisinin combination therapy (ACT)
for vivax/ovale: primaquine

Question 4

Remarks on primaquine

Answer 4

First check for G6PD deficiency.
Alternative is chloroquine

Question 5

Drug options for severe (complicated) malaria

Answer 5

1. Artesunate
2. Quinidine + (Doxycycline or Clincamycin [if <8y])

For a maximum of 7 days

Question 6

Remarks on management of malaria

Answer 6

1. Do not delay treatment while awaiting laboratory confirmation.

Question 7

Drug of choice for severe malaria

Answer 7

IV ARTESUNATE
- rapidly effective and extremely potent against all erythrocyte stages
- does not cause cardiac toxicity or hypoglycemia
- effective and is superior to IV quinine or quinidine in both adults and children

artesunate’s major limitation at present in the US is its lack of timely availability

Question 8

Steroids in malaria

Answer 8

Glucocorticoids are of NO PROVEN BENEFIT for cerebral malaria and should not be used.Co

Question 9

Precautions for quinine or quinidine

Answer 9

Major toxicity: Cardiac dysrhythmias, hypoglycemia (potent inducers of insulin release), abortions, neuromuscular paralysis (myasthenia)

Question 10

Precautions for chloroquine

Answer 10

Major toxicity: retinopathy after prolonged use

Avoid in patients with severe psoriasis and some types of porphyria

Question 11

Precautions in primaquine

Answer 11

Minor toxicity: methemoglobinemia
Major toxicity:
- massive hemolysis in G6PD deficiency
- exacerbation of SLE or RA