Anti-Parasitics

Question 1

Chloroquine-resistant P. falciparum

Answer 1

Mefloquine + pyrimethamine/sulfoxadine (Fansidar) OR clindamycin OR tetracycline OR doxycycline
• Quinidine gluconate IV followed by PO quinine (for severe illness)
• Alternate regimens
(i) Atovaquone + proguanil

Question 2

Severe illness or NPO:

Answer 2

• Parenteral quinine
• Quinidine gluconate IV followed by PO quinine to complete 3 days
IV quinidine requires EKG & Vital signs monitoring

Question 3

Uncomplicated attack

Answer 3

(all species except chloroquine-resistant P. falciparum) – Chloroquine

Question 4

Alternate regimens:

drug for P. vivax or P. ovale

Answer 4

Primaquine

Question 5

Alternate Regimens:

drug for P. falciparum

Answer 5

Atovaquone + proguanil

Question 6

Chloroquine-resistant P. falciparum

Answer 6

Mefloquine (Larium) - Begin 1 week prior to departure and continue for 4 weeks after leaving endemic area. Can use doxycycline in patients who can not tolerate mefloquine

Question 7

Prevention for all species

Answer 7

Chloroquine phosphate 300 mg PO q week. Begin 1 week prior to departure and continue for 4 weeks after leaving endemic area

Question 8

Giardiasis treatment

Answer 8

(i) metronidazole
(ii) tinidazole
(iii) nitazoxinide (Alinia)– can produce yellow sclera
(iv) furazolidine – Avoid alcohol. Cause brown urine color
(v) Paromycin – can use in kids

Question 9

systemic treatment for intestinal and liver amebiasis

Answer 9

Metronidazole (Flagyl) OR tinidazole (Tindamax) + luminal agent. Avoid alcohol with metronidazole & tinidazole. Also they are contraindicated in first trimester of pregnancy.

Question 10

Luminal treatment for amebiasis: Use in asymptomatic cyst passers

Answer 10

• paromycin (Humatin)

* iodoquinol (Yodoxin) – CI if iodine intolerant