Malaria Prophylaxis

Question 1

Who should avoid travel to malarious zones?

Answer 1

Asplenic people

Pregnant women

Question 2

What is the most effective bite prevention?

Answer 2

Nets with permethrin

Question 3

How do you apply DEET 20-50%?

Answer 3

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

Question 4

Who can use DEET?

Answer 4

Adults and children above 2 months

Question 5

What are the counselling points for travellers?

Answer 5

Inform travellers of importance of avoiding mosquito bites and taking prophylaxis regular,y

Chemoprophylaxis is not absolute

Breakthrough malaria can occur

Question 6

What are the drugs used in antimalarial prophylaxis regimens?

Answer 6

Malarone - atovaquone + proguanil

Chloroquine only

Chloroquine + proguanil

Mefloquine

Doxycycline

Proguanil only

Question 7

What counselling points are specific to doxycycline?

Answer 7

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

Question 8

What are the counselling points for mefloquine?

Answer 8

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

Question 9

Who is mefloquine contraindicated in?

Answer 9

Patients with a history of psychiatric disorders (including depression) or convulsions

Question 10

What is the normal length of prophylaxis?

Answer 10

Usually 1 week before travel, during, and 4 weeks after travel

Question 11

What is the length of prophylaxis for mefloquine?

Answer 11

2-3 weeks before, during and 4 weeks after

Question 12

What is the length of prophylaxis for malarone?

Answer 12

1-2 days before, during and 1 week after

Question 13

What is the length of prophylaxis for doxycycline?

Answer 13

1-2 days before, during and 4 weeks after

Question 14

What is the length of long term prophylaxis for malaria?

Answer 14

> 5 years chloroquine and proguanil

2 years doxycycline

1 year mefloquine, malarone

Question 15

Which antimalarials should you avoid in epilepsy?

Answer 15

Chloroquine/mefloquine

Question 16

Which antimalarials should you avoid in renal impairment?

Answer 16

Proguanil
Malarone and chloroquine if eGFR < 30ml/min

Choose doxycycline or mefloquine

Question 17

Which antimalarials can you give in pregnancy?

Answer 17

Chloroquine and proguanil
5mg folic acid with proguanil

Doxycycline contraindicated

Avoid mefloquine
Avoid malarone (can give in 2nd or 3rd trimester if no alternative)

Question 18

What considerations need to be made for chemoprophylaxis if the patient is on warfarin?

Answer 18

Start 2-3 weeks before

INR should be stable before departure

Monitor INR before, 7 days after starting and after completing course

Question 19

Which antimalarials can be given OTC?

Answer 19

Proguanil
Chloroquine
Chloroquine + proguanil

Question 20

If any illness occurs within 1 year of returning from malarial region, you should…

Answer 20

… see GP immediately and specifically mention malaria exposure

Question 21

What drugs are used in the treatment of malaria?

Answer 21

Quinine
Malarone
Riamet

Chloroquine - non-falciparum malaria

Question 22

When should quinine be taken for the treatment of malaria?

Answer 22

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