Malaria

Question 1

NETS (bite prevention) impregnated with

Answer 1

Permethrin

Question 2

DEET (bite prevention)

Answer 2

DEET 20-50%
- apply to skin
- safe/effective for >2m
- apply suncreen 1st
- 50% = longest protection

Question 3

List of anti-malarial prophylaxis regimens

Answer 3

• Malarone
• Chloroquinine alone
• chloroquinine + Proguanil
• Mefloquinine
• Doxycycline

Question 4

counselling: Doxycyline in malaria prophylaxis

Answer 4

• protect skin from sunlight
• do not take indigestion remedies, iron, zinc 2h before or after
• swallow whole with water while standing or sitting

Question 5

Doxycyline in malaria prophylaxis - how to take

Answer 5

1-2 days before + 4 weeks after

Question 6

Mefloquine contraindication

Answer 6

if Hx of psychiatric disorder (incl. depression) or convulsions

Question 7

Mefloquine and driving

Answer 7

dizziness, disturbed sense of balance - persists several months after stopping
- has long half-life

Question 8

Mefloquine cautions

Answer 8

SERIOUS neuropsychiatric reactions
- psychosis, suicidal reported
- Prodomal symptoms = nightmares, insomnia, depression, anxiety, confusion
- STOP & seek medical attention

Question 9

Mefloquine how to take

Answer 9

2-3 weeks before & 4 weeks after

Question 10

Malarone how to take

Answer 10

1-2 days before & 1 week after

Question 11

Long term prophylaxis - chloroquine & proguanil

Answer 11

> 5y

Question 12

long term prophylaxis of malaria doxycyline

Answer 12

2y

Question 13

long term prophylaxis -mefloquine or malarone

Answer 13

1y

Question 14

Malaria & EP

Answer 14

AVOID
chloroquine
Mefloquine

Question 15

Malaria & Renal impairment

Answer 15

AVOID proguanil

avoid malarone/chloroquine if eGFR<30

CHOOSE = Doxycyline, Mefloquine

Question 16

Malaria and Pregnancy

Answer 16

Chloroquine + Proguanil
+ 5mg Folic acid (With proguanil)

• doxycyline contraindicated
• avoid mefloquine (manufracturer)
• avoid malarone (if no alternative can give in 2/3 trimester)

Question 17

Malaria & Anticoagulants (warfarin)

Answer 17

start prophylaxis 2-3 weeks before
INR should be stable before leaving
- monitor INR before, 7 days after starting and completing course
- prolonged stay = regular INR

Question 18

CHEMOPROPHYLAXIS summary table

Answer 18

Question 19

Any illness (malaria) within … = treat

Answer 19

any illness within 1y
(esp. the first 3 months of return)

Question 20

Malaria tx option - falciparum malaria

Answer 20

• quinine
• malarone
• riamet (artmether + lumefantrine)

Question 21

Malaria tx option - non-falciparum malaria

Answer 21

chloroquine