Malaria Flashcards
Background
Malaria - ABCD:
A - Aware of symptoms
B - Bite prophylaxis
C - Chemoprophylaxis
D - Diagnosis on return
2 Types of malaria
- Non falciparum
- Falciparum
Non Falciparum - NON fatal
Falciparum - FATAL
- They both caused by 2 different parasites.
NON F - plasmodium vivax (vivax means long lived/ keeps alive)
F - Plasmodium falciparum
Falciparum M - Multiply rapidly in blood and most dangerous type
Main form of transmission is through mosquito bites
Symptoms
Fever
Chills
Persistent headache/Cough
Diarrhoea
NV
Muscle pain
Sweats
Chest/Abdo pain
Different malaria drugs
Mefloquine (lariam) POM
Used for prophylaxis
- Rarely used now due to resistance
AEs: Neuropsychiatric reactions (Lari is mental)
AVOID in epilepsy.
Malarone/Maloff protect P
(Atovaquone/Proguanil)
Prophylaxis and Treatment
- Treat uncomplicated Falciparum and all NON falciparum
is ALT to mefloquine or doxycycline
- Suitable for short tris as only needed to be used for 7 days after leaving endemic area
Quinine
For Treatment only,
- Associated with QT prolongation.
Doxycycline
Used in adults and children >12 for Prophylaxis in mefloquine and Chloroquine resistant areas.
Chloroquine - P
Prophylaxis advice
Drugs aren’t 100% effective so need to take other measures.
Long sleeves
Sunscreen
Insect repellent (DEET 50%)
Mosquito nets sprayed with permethrin (most effective barrier)
DEET 50% - safe for children >2months, Pregnancy/BF.
- Apply after sunscreen
- DEET reduces SPF of sunscreen so use SPF 30-50
Length of prophylaxis
BEFORE
Mefloquine OW - 2/3weeks
Doxy OD - 1/2days
Malarone OD - 1/2 days
Others OW - 1 week
- NB: Mefloquine, Malarone - can be used for up to 1yr
Doxy - Up to 2yrs
AFTER -
ALL 4 weeks EXCEPT Atova/Proguanil is 1 week.
Returning from Malaria region
Monitor for 1 yr after coming back esp. first 3 months.
- Any illness that happens within this yr or first 3 months can be malaria.
- Travellers should report any illness to DR ASAP. Malaria - notifiable disease
Prophylaxis in epilepsy
AVOID QUINS in epilepsy
- Chloroquine, quinine, Mefloquine.
Give:
- Doxy, Atova + proguanil (Malarone, Maloff protect)
Prophylaxis Pregnancy (EXAM Q)
Should AVOID travel to malarious areas when pregnant
Chloroquine can be given but not the most effective in most areas.
Mefloquine given in 2nd/3rd trimester - in the 1st only if benefit outweighs risk.
Doxy - only if no other choice and can be completed b4 15 weeks of gestation
Atova/Proguanil (malarone) AVOID but can be used in 2nd/3rd if no ALTs - if given also give folic acid.
Malaria with Anticoagulants
INR must be stable b4 holiday.
- Malaria drugs affect INR. stabilising helps avoid bleeding.
Warfarin PTs should start chemoprophylaxis 2/3weeks b4 travel
Measure INR b4 prophylaxis, says after starting and after completing prophylaxis.
- For longer stays check INR more regular
Limited info on DOAC and chemoprophylaxis
Falciparum TREATMENT
Initial - Hospital admission
Uncomplicated - Tabs
Complicated - V severe - IV drugs
Uncomplicated
1st line - Artemether with lumefantrine (Artemisinin combo)
ALT - Oral Quinine or Atovaquone +Proguanil (Malarone)
- Quinine is effective but poorly tolerated in prolong treatment so given WITH:
- doxycycline OR
- Clindamycin (unlicensed in pregnant and children)
For pregnancy typically give Quinine + Clindamycin.
Severe/Complicated
1st line - IV Artesunate (for severe cases or high risk PT)
Follow up - Oral Artemisinin combo after IV
Follow up ALT - Full course oral Quinine with doxy or clinda or Malarone.
- IF IV Artesunate not available use IV quinine and continue until PT able to take oral to complete course. Also give oral doxy or Clinda when PT can swallow.
Treatment Falciparum Malaria in Pregnancy
Uncomplicated
High risk: severe disease, close obs in hospital
2nd/3rd trimester - Artemether with lumefantrine (artemisinin combo)
ALT All trimester - Quinine + Clindamycin.
- NB: Quinine can increase risk of uterine contraction and hypoglycaemia.
Severe/Complicated
High risk: Fatality, Pregnancy loss and complications
Preferred treatment: IV Artesunate in ANY trimester
ALT IV Quinine + Clindamycin
Treatment on NON falciparum (non serious form)
Uncomplicated
Either Artemisinin combo (artemether + lumefantrine) OR chloroquine
- Artemisinin preferred.
Radical treatment needed then Chloroquine + Primaquine
- Primaquine screen for G6PD deficiency as can cause haemolysis if G6PD deficient.
Severe/Complicated
IV Artesunate or IV quinine
Pregnancy - NON falciparum
Weekly Chloroquine throughout pregnancy instead of primaquine untill delivery or completion of breast feeding for p.vivax/p.ovale
2nd/3rd trimester can use artemisinin combo
1st trimester: Quinine if concern about chloroquine resistant p.vivax
Safety INFO
Quinine:
- Causes QT prolongation
Mefloquine:
- Neuropsychiatric reactions (eg Depression, insomnia, anxiety etc) - STOP if occur
Chloroquine:
- Ocular toxicity - In adults if dose >4mg/kg daily.
- MHRA - Increase risk of CV event when used with macrolides.
Proguanil Update (MHRA)
Drugs been STOPPED on its own only comes with atova.
