Malaria

Question 1

What advise should you give regarding Bite prevention in malaria ?

Answer 1

NETS with permethrin are most effective
DEET 20-50%: safe for 2months+
50% provides the longest protection.
Long sleeves and trousers after dusk.

Question 2

How should patients apply SPF when using DEET ?

Answer 2

apply sunscreen first and use at least SPF 35 to 50 as DEET reduces the SPF

Question 3

Name antimalarials available ?

Answer 3

MALARONE ( atovaquone + proguanil)
CHLORUINE ONLY
CHLOROQUINE + PROGUANIL
MEFLOQUINE
DOXYCYCLINE

Question 4

What are the key counselling points when taking doxycycline for MALARIA prophylaxis ?

Answer 4

1. take one to two days before entering endemic area, continue for 4 weeks after leaving
2. Protect your skin from sunlight
3. Do not take indigestion remedies, iron or zinc, 2 hr before or after.
4. Capsules swallow while sitting or standing during meals.

Question 5

What type of serious neuropsychiatric reactions can mefloquine cause ?

Answer 5

1. psychosis, suicidal ideation.
2. Prodromal symptoms for a serious event: abnormal dreams, insomnia, nightmares, depression, anxiety, restlessness, confusion.

Question 6

What are the key counselling points for mefloquine ?

Answer 6

1. stop and seek immediate attention if neuropsychiatric effects occurs
2. Can cause dizziness and disturbed sense of balance: can persist for several months after stopping, careful with driving

Question 7

When would mefloquine be contraindicated ?

Answer 7

history of psychiatric disorders, convulsions, depression

Question 8

Most antimalarials are used 1 week before travel, but how long before should doxycycline, mefloquine, malarone be started ?

Answer 8

mefloquine: 2-3 weeks

malarone/doxycycline 1-2 days before

Question 9

Most antimalarials are used for 4 weeks after travelling, but how long is malarone used for ?

Answer 9

1 week

Question 10

For long term prophylaxis, how long can doxycycline, mefloquine, malarone, chloroquine and proguanil be used ?

Answer 10

doxycycline: 2 years
Cloroquine and proguanil : more than 5 years
mefloquine, malarone: one year

Question 11

In epilepsy which antimalarials should be avoided ?

Answer 11

chloroquine/mefloquine

Question 12

In renal impairment which antimalarials should be avoided ?

Answer 12

avoid proguanil

avoid malarone and chloroquine if eGFR less than 30 mil/min

Question 13

which antimalarials are suitable in renal impairment ?

Answer 13

doxycycline or mefloquine

Question 14

Which antimalarials can be given in pregnancy ?

Answer 14

chloroquine and proguanil

Question 15

if proguanil is given for malaria prophylaxis during pregnancy, what else should be given ?

Answer 15

folic acid 5 mg

Question 16

Which antimalarials should be avoided in pregnancy ?

Answer 16

doxycycline
mefloquine
malarone ( no alternative, can give in 2nd and 3rd trimester)

Question 17

What is the advise for patients who take warfarin and needs antimalarial prophylaxis ?

Answer 17

start prophylaxis 2-3 weeks before
INR should be stable before departure
Monitor INR before starting, 7 days after starting, after completing the course

Question 18

How should mefloquine and chloroquine be taken ?

Answer 18

once weekly

Question 19

What is the treatment for falciparum malaria ?

Answer 19

quinine, malarone, riamet

Question 20

What is the treatment for non-falciparum malaria ?

Answer 20

chloroquine