Malaria Prophylaxis Flashcards
Who should avoid travel to malarious zones?
Asplenic people
Pregnant women
What is the most effective bite prevention?
Nets with permethrin
How do you apply DEET 20-50%?
To the skin
Spray or lotion
Apply sunscreen first and at least SPF 35-50 as DEET reduces SPF
50% provides longest protection
Wear long sleeves and trousers after dusk
Who can use DEET?
Adults and children above 2 months
What are the counselling points for travellers?
Inform travellers of importance of avoiding mosquito bites and taking prophylaxis regular,y
Chemoprophylaxis is not absolute
Breakthrough malaria can occur
What are the drugs used in antimalarial prophylaxis regimens?
Malarone - atovaquone + proguanil
Chloroquine only
Chloroquine + proguanil
Mefloquine
Doxycycline
Proguanil only
What counselling points are specific to doxycycline?
Take 1-2 days before entering endemic area and continue for 4 weeks after leaving
Protect skin from sunlight
Do not take indigestion remedies 2 hours before or after you take this medicine
Swallow whole with plenty of fluid during meals while sitting or standing
What are the counselling points for mefloquine?
Serious neuropsychiatric reactions - stop and seek immediate medical attention to replace with alternative antimalarial if neuropsychiatric effects occur
Driving - dizziness and disturbed sense of balance can persist up to several months after stopping
Who is mefloquine contraindicated in?
Patients with a history of psychiatric disorders (including depression) or convulsions
What is the normal length of prophylaxis?
Usually 1 week before travel, during, and 4 weeks after travel
What is the length of prophylaxis for mefloquine?
2-3 weeks before, during and 4 weeks after
What is the length of prophylaxis for malarone?
1-2 days before, during and 1 week after
What is the length of prophylaxis for doxycycline?
1-2 days before, during and 4 weeks after
What is the length of long term prophylaxis for malaria?
> 5 years chloroquine and proguanil
2 years doxycycline
1 year mefloquine, malarone
Which antimalarials should you avoid in epilepsy?
Chloroquine/mefloquine
Which antimalarials should you avoid in renal impairment?
Proguanil
Malarone and chloroquine if eGFR < 30ml/min
Choose doxycycline or mefloquine
Which antimalarials can you give in pregnancy?
Chloroquine and proguanil
5mg folic acid with proguanil
Doxycycline contraindicated
Avoid mefloquine Avoid malarone (can give in 2nd or 3rd trimester if no alternative)
What considerations need to be made for chemoprophylaxis if the patient is on warfarin?
Start 2-3 weeks before
INR should be stable before departure
Monitor INR before, 7 days after starting and after completing course
Which antimalarials can be given OTC?
Proguanil
Chloroquine
Chloroquine + proguanil
If any illness occurs within 1 year of returning from malarial region, you should…
… see GP immediately and specifically mention malaria exposure
What drugs are used in the treatment of malaria?
Quinine
Malarone
Riamet
Chloroquine - non-falciparum malaria
When should quinine be taken for the treatment of malaria?
Standby treatment of malaria
Only if you cannot access medical care in 24 hours of fever onset
Give with written instructions that urgent help is required if fever > 38 degrees, 7 days or more after arriving in malarious zone
