Malaria Prevention Flashcards
Malaria Prevention - Risk Assessment Components (3 parts)?
- Person - VFR, extremes of age, pregnancy, immunosuppressed, co-morbidities
- Place - Sub-Saharan Africa, areas of deforestation, rural vs urban, accommodation type
- Time - longer term travellers, seasonality
Malaria Prevention - Insect Repellant Options?
- DEET - reapply q6-8h, 50%, >2 mo of age, ok for preg and breastfeeding
- Icaridin - 20%, >6 mo of age, q4-6h
- IR3535 - use highest strength, >2 mo of age, q6-8h, not helpful for Anopheles
Malaria Prevention - Chemoprophylaxis options in Chloroquine-sensitive region?
1st line –> Chloroquine
2nd line –> Hydroxychloroquine
Both taken once weekly starting 1 week before travel to area, during exposure, and 4 weeks after leaving malaria-endemic region.
3rd line –> Atovaquone-proguanil, doxycycline, mefloquine
Malaria Prevention - Chemoprophylaxis options in Chloroquine-resistant regions?
Drugs of choice: Atovaquone-proguanil, doxycycline or mefloquine
2nd line: primaquine daily
-If mefloquine resistance, use either of other two
Malaria Prevention - Chloroquine-sensitive regions?
Haiti, Dominican Republic, Central America north of the Panama Canal, parts of Mexico, parts of South America, north Africa, parts of Middle East, and west/central China
Malaria Prevention - Chloroquine-resistant regions?
Most of sub-Saharan Africa, South America, Oceania and Asia
-Some mefloquine resistance in border areas of Thailand, Myanmar, Laos and Cambodia, and southern Vietnam
-Now almost worldwide however
Malaria Prevention - Atovaquone-proguanil chemoprophylaxis dosing?
Malarone
-Daily
-Start 1 day before until 7d after
Considerations: DDI, renal dosing (avoid if eGFR <30), needs fatty meal (milky drink), cannot crush
Pregnancy/BF: ok in 2nd trimester, data in 1st trimester
Side effects: neuro, GI, hair loss
Malaria Prevention - Doxycycline chemoprophylaxis dosing?
-Daily
-1 day before until 4 weeks after
Considerations: DDI
Pregnancy/BF: up until 15 wks, no BF and no for children?
Side effects: gastritis, teratogen, bones/teeth, photosensitivity
Malaria Prevention - Mefloquine chemoprophylaxis dosing?
-Weekly
-3 weeks before until 4 weeks after
Considerations: DDI, psych hx (don’t give), can crush, epilepsy issues, anticoag issues
Pregnancy/BF: ok
Side effects: neuro psych (dreams, insomnia, anxiety, depression)
-Many people discontinue due to side effects, 95% of ADRs by 3rd dose
Malaria Prevention - Tafenoquine chemoprophylaxis dosing?
-Monthly for 6 months vs weekly?
-Unclear access in Canada
Malaria Prevention - Pregnancy Risks?
-Increased risk of severe malaria
-Placental sequestration (can delay diagnosis)
-Congenital malaria (rare but more common with vivax)
Malaria Risks - Pregnancy Prophylaxis
-Chloroquine/Proguanil –> ok in all trimesters, folic acid with proguanil but resistance
-Mefloquine - all trimesters
-Doxycycline - under special circumstances <15 weeks + 4 weeks on return
-Atov/Prog - data sparse, take folic acid for duration
Malaria Prevention - Proph for Epilepsy?
- Doxy YES
- Atov/Prog YES
- Chloroquine NO
- Mefloquine NO
Malaria Prevention - Children Chemoproph?
-Mefloquine easiest - >5kg, weekly
-Atov/Prog - >5kg with milk/yogurt daily
-Doxy >12 years old
Malaria Prevention - Chemoproph in renal disease?
- Atov/Prog - avoid if eGFR <30 (can do dose reductions if needed)
- Mefloquine - ok in severe disease
-Doxycycline - ok in severe disease