malaria

Question 1

bite protection imp points

Answer 1

prevention better than cure

mosquito nets with permethrin

deet 20-50% (50% longer protection - 1st line)
- suitable for anyone > 2 months
- avoid ingesting - wash hands before eating

apply DEET after sunscreen
- DEET reduces SPF - use high SPF 30-50

Question 2

malaria prophylaxis duration

Answer 2

1 malorone (atovaquone with proguanil)
2 chloroquine
3 proguanil
4 mefloquine
5 doxycycline

before travel:
1 - 1/2 days
2 - 1 week
3 - 1 week
4 - 2 weeks
5 - 1/2 days

dosage:
1 - OD
2 - 1 weekly
3 - OD
4 - 1 weekly
5 - OD

after travel:
1 - 1 week
2 - 4 weeks
3 - 4 weeks
4 - 4 weeks
5 - 4 weeks

max use:
1 - 1 year
2 - long term
3 - long term
4 - 1 year
5 - 2 years

any illness within 1 year esp 3 months of returning from a malaria zone - might be malaria - see doc and mention malaria

Question 3

asplenic or pregnant patient

Answer 3

asplenic pts - severe risk of malaria

pregnant
- avoid malarious regions
- only chloroquine can be given - avoid others
- take 5mg folic acid - due to neural tube defect risk

Question 4

epilepsy and warfarin patients

Answer 4

epilepsy:
- avoid chloroquine and mefloquine
- quinines reduce seizure threshold

warfarin:
- begin treatment 2/3 weeks before departure
- INR should be stable before departure
- measure INR before anti-malarials, 7 days after starting and after completing course
- prolonged stays check INR regularly

Question 5

antimalarial med cautions

Answer 5

mefloquine
- history of psychiatric disorders
- history of convulsions
- stop if these develop

chloroquine
- history of convulsions
- can be retinotoxic

proguanil
- renal impairment -reduce dose

doxycycline
- avoid exposure to sunlight

Question 6

standby treatment

Answer 6

travellers can self medicate with standby treatment if more than 24hrs away from medical care

seek urgent medical attention if fever (38+) develops 7+ days after arriving in malarious area

self-treat if medical help not available within 24 hrs of fever onset