Malaria

Question 1

What is the resolution of avoiding malaria

Answer 1

To avoid being bitten by mosquitos but this is not absolute

Can also try doing the following

• get a mosquito net impregnated with permethrin
• diethyltoluamide (DEET) 20-50% (50% last longer protection)
  -suitable for anyone over the age of 2 months
  -avoid ingestion- wash hands before eating
  -suitable for pregnancy and breastfeeding (wash breast before feeding)
  Apply DEET after sunscreen
  -DEET reduces SPF of sunscreen- use high SPF lotion

Question 2

What is the prophylaxis’s treatment of malaria

Answer 2

Malarone - this is atovaquone and proguanil
Before travel 1-2 days
Dosage 1 daily
After travel 1 week
Maximum use 1 year

Chloroquine
Before travel 1 week
Dosage 1 weekly
After travel 4 weeks
Maximum use long term

Proguanil
Before travel 1 week
Dosage 1 daily
After travel 4 weeks
Maximum use long term

Mefloquine
Before travel 2-3 weeks
Dosage 1 weekly
After travel 4 weeks
Maximum use 1 year

Doxycycline
Before travel 1-2 days
Dosage 1 daily
After travel 4 weeks
Maximum use 2 years

Illness occurring within 1 year, especially 3 months of return,
Might still be malaria- see doctor early, mentioning malaria

Question 3

What are the different patient groups and what to advise

Answer 3

Asplenia- patients without a spleen
-They are at risk of severe malaria

Pregnancy
- avoid travelling in malarious regions
-Chloroquine and proguanil can be given- avoid other medications
- take 5mg of folic acid as well due to neural tube defect risk

Epilepsy
- avoid chloroquine and mefloquine

Patients on warfarin
- being treated 2-3 weeks before departure
-INR should be stable before departure
- measure INR before anti malaria, 7 days after starting and after completing the course
- prolonged stays - check INR regularly

Question 4

What are the different cautions of antimalarial medications

Answer 4

Mefloquine
- history of psychiatric disorders- if these develop = stop and seek medical attention
- history of convulsions

Chloroquine
-history of convulsions
-can be retinotoxic

Proguanil
- renal impairment- reduce the dose

Doxycycline
- avoid exposure to sunlight

Question 5

What is meant by standby treatment

Answer 5

Travellers visiting remote areas should carry standby emergency treatment if they are likely to be more than 24 hours away from medical care

Self medication should be avoided if medical help is accessible

Traveler should be written with the following instructions
- seek urgent medical attention if fever 38 degrees develops 7+ days after arriving in malarious area
- self treat if medical help is not available within 24 hours of fever onset