Malaria prophylaxis Flashcards
Prophylaxis is not absolute,and breakthrough infection can occur with any of the drugs recommended. outline the advice provided regarding Protection against bites
1) nets impregnated with permethrin most effective barrier
2) DEET 20–50%, safe and effective on skin of adults and children over 2 months of age. Also okay in pregnancy and BF but wash hands before feeding
3) duration of protection varies on concentration. DEET 50% longest
4) Long sleeves and trousers worn after dusk
how should DEET be applied when sunscreen is also required?
1) DEET should be applied after the sunscreen
2) DEET reduces the SPF so use SPF 30–50
In order to determine tolerance and to establish habit, prophylaxis should generally be started before travel into an endemic area. when should the following be started? 1) chloroquine and proguanil 2) Mefloquine 3) Malarone or doxycycline
1) 1 week before for chloroquine and proguanil
2) 2–3 weeks before travel for mefloquine
3) 1–2 days before travel for malarone or doxycycline
how long should prophylaxis be continued for after returning ?
1) 4 weeks after leaving the area
2) Except malarone- stopped 1 week after leaving
In those requiring long-term prophylaxis of malaria, which drugs can be considered?
1) chloroquine and proguanil may be used
2) Mefloquine is licensed for up to 1 year ( may cause harm if used up to 3 years).
3) Doxycycline up to 2 years
4) Malarone up to 1 year
what should be considered when returning from a malarial region?
1) illness within 1 year and especially within 3 months of return might be malaria
2) inform patients if any illness particularly within 3 months of return inform GP immediately
1) which antimalarials should be avoided in those with a history of epilepsy?
2) which ones are suitable?
1) Chloroquine and mefloquine are unsuitable
2) Doxycycline or malarone may be used.
↳( doxycycline may interact with some antiepileptics and its dose may need to be adjusted)
How should patients with asplenia be managed?
at particular risk of severe malaria. If travel to malarious areas is unavoidable, rigorous precautions are required against contracting the disease.
Travel to malarious areas should be avoided during pregnancy but if travel is essential what drugs can be used?
1) Chloroquine and proguanil can but lots of resistance
2) If high risk area, mefloquine can be used during the 2-3 trimester of pregnancy. used in 1st if benefits outweigh
3) Doxycycline C/I in pregnancy; Consider if the entire course of can be completed before 15 weeks gestation
4) Malarone avoided during pregnancy, but consider in 2-3 trimesters if there is no suitable alternative
what supplements should be given when proguanil or malarone is used for prophylaxis in pregnancy?
Folic acid - dosed as a pregnancy at ‘high-risk’ of neural tube defects
outline the information regarding prophylaxis of malaria in Breast-feeding
1) Some antimalarials should be avoided when BF
2) Prophylaxis is required in breast-fed infants- amounts in milk too small for protection
what is the guidance regarding Anticoagulants and chemoprophylaxis?
1) if taking warfarin begin chemoprophylaxis 2–3 weeks before departure, INR should be stable before leaving
2) Measured before starting chemoprophylaxis, 7 days after starting, and after completing the course.
outline the guidance regarding Standby treatment
1) standby treatment if likely to be more than 24 hours away from medical care. Dont Self-medicate
2) provide traveler with written instructions that urgent medical attention should be sought if fever (38°C or more) develops 7 days (or more) etc.
what is the advice surrounding settled immigrants (or long-term visitors) to the UK regarding prophylaxis?
any immunity they may have acquired is lost rapidly after migration to the UK, or that any non-malarious areas where they lived previously may now be malarious.
