Antimalarials

Question 1

Atovaquone with proguanil is licenced for what? Malarone®

Answer 1

is licensed for the prophylaxis of falciparum malaria and for the treatment of acute, uncomplicated falciparum malaria.

Question 2

what is Artemether with lumefantrine (Riamet) tablets licenced for?

Answer 2

treatment of acute uncomplicated falciparum malaria

Question 3

outline the use of Chloroquine in malaria

Answer 3

1) Chloroquine usually used with proguanil for prophylaxis in areas where there is little chloroquine resistance
2) Not for the treatment of falciparum due to resistance. also not recommended if species is not known or mixed. but quinine, malarone, or riamet would be okay

Question 4

According to public Health England, do patients need malaria prevention if they are already taking hydroxychloroquine sulfate for another indication?

Answer 4

if already taking hydroxychloroquine and in whom chloroquine would be an appropriate antimalarial, patient can remain on hydroxychloroquine sulfate
3) recommended for non-falciparum malaria

Question 5

outline the use of doxycycline in malaria

Answer 5

1) 12 years+ for the prophylaxis in areas of widespread mefloquine or chloroquine resistance
2) Also used analternative to mefloquine or malarone

Question 6

outline the use of mefloquine in malaria

Answer 6

1) prophylaxis of malaria in areas where there is a high risk of chloroquine-resistant falciparum malaria
2) Now rarely used to treat falciparum malaria due to resistance

Question 7

what is the role of Primaquine in the treatment of malaria?

Answer 7

used to eliminate the liver stages of P. vivax or P. ovale following chloroquine treatment

Question 8

outline the use of Proguanil in the treatment of malaria

Answer 8

1) used in combination with chloroquine or atovaquone for the prophylaxis of malaria
2) Malarone - licensed for acute treatment of falciparum, and also used for the prophylaxis of falciparum malaria in mefloquine or chloroquine resistant areas

Question 9

what is Atovaquone with proguanil (malarone) good for short trips to highly chloroquine-resistant areas

Answer 9

it needs to be only be taken for 7 days after leaving an endemic area

Question 10

what is quinine used for in malaria?

Answer 10

1) not suitable for the prophylaxis of malaria

2) used for the treatment of falciparum malaria, if the infective species is not known, or if the infection is mixed

Question 11

what is the role of Pyrimethamine in malaria?

Answer 11

1) Pyrimethamine is used with sulfadoxine. not for prophylaxis
2) treatment of falciparum malaria with (or following) quinine

Question 12

what side effect should be monitored in those taking chloroquine?

Answer 12

1) need to screen for ocular toxicity especially with long term treatment of chloroquine and hydroxchloroquine
2) toxic in overdose and difficult to treat

Question 13

what are the cautions regarding the use of mefloquine?

Answer 13

1) not licenced for under 3m (under 5kg)
2) Avoid in cardiac conduction disorders, epilepsy
3) neuropsychiatric reactions: e.g. insomnia, anxiety, depression. adverse effects might occur and persist for several months due to long half life
4) patient alert card, and driving and skilled tasks

Question 14

what should be screened for in people before administering primaquine?

Answer 14

blood should be tested for glucose-6-phosphate dehydrogenase (G6PD) activity since it can cause haemolysis

Question 15

what are the cautions regarding the use of quinine?

Answer 15

1) dose dependent QT prolongation effects
2) very toxic in overdose
3) High doses are teratogenic in first trimester, but in malaria benefit outweighs the risk