Malaria Prophylaxis

Question 1

What non-pharmacological methods can be taken to prevent mosquito bites?

Answer 1

Long sleeves and trousers after dusk, mosquito nets impregnated with permethrin, mats and vapourised insecticides.

Question 2

Diethyltoluamide (DEET) preparations of 20-50% are safe in which patient groups?

Answer 2

When applied to the skin of adults and children over 2 months, as well as pregnant and breastfeeding women.

Question 3

What effect does DEET have on sun cream and how should this be treated?

Answer 3

DEET can reduce the SPF of sun cream, a high SPF cream should be used, DEET should be applied after the sun cream.

Question 4

When should use of mefloquine for malaria prophylaxis be started?

Answer 4

2-3 weeks before travel to the endemic area.

Question 5

When should use of Malarone or doxycycline for malaria prophylaxis be started?

Answer 5

1-2 days before travel to the endemic area.

Question 6

For how long should malaria prophylaxis be continued after return from the endemic area?

Answer 6

For 4 weeks after leaving the endemic area, except for Malarone which should be stopped after 1 week.

Question 7

After return from an area where there may be a risk of malaria, for how long could illness potentially be malaria?

Answer 7

Any illness withing one year and especially within three months of return. Travellers should immediately go to the doctors.

Question 8

Which antimalarial drugs are unsuitable in epileptic patients?

Answer 8

Chloroquine and mefloquine.

Question 9

Describe the relationship between asplenia and malaria.

Answer 9

Asplenic patients have an increased risk of severe malaria. They should take special care to not contract malaria.

Question 10

Can proguanil for malarial prophylaxis be used in patients with renal impairment?

Answer 10

No.

Question 11

What is the eGFR which prevents the use of Malarone for malaria prophylaxis?

Answer 11

Less than 30.

Question 12

Do breastfed infants require their own malaria prophylaxis?

Answer 12

Yes, the amount of antimalarial medication present in breastmilk is too variable to be relied on.

Question 13

How long before travel should patients on warfarin start malaria prophylaxis?

Answer 13

2-3 weeks prior to travel.

Question 14

With regards to malaria prophylaxis, when should a warfarin patient’s INR be monitored?

Answer 14

Before chemoprophylaxis, seven days after starting, and after completing the course. INR should be stable prior to travel.

Question 15

What specific toxicity has been observed with use of chloroquine (Avloclor)?

Answer 15

Ocular toxicity, screening is recommended.

Question 16

Ocular toxicity with chloroquine is uncommon when the dose is under what?

Answer 16

4mg/kg.

Question 17

In which patient is use of mefloquine contraindicated?

Answer 17

Those with a history of psychiatric disorders.

Question 18

What side effects occur commonly with mefloquine use?

Answer 18

Abnormal dreams, insomnia, anxiety, depression.

Question 19

What less common side effects have been reported with mefloquine use?

Answer 19

Psychosis, suicidal ideation, and suicide.

Question 20

Which signs should be regarded as a sign of a more serious even if they occur when a patient is taking mefloquine for malaria prophylaxis?

Answer 20

Nightmares, anxiety, depression, restlessness, confusion.

Question 21

What should patients on mefloquine do if they experience any psychiatric side effects?

Answer 21

Discontinue treatment and seek medical attention. Side effects can last a long time due to the long half-life of the drug.

Question 22

How can driving be affected by mefloquine use?

Answer 22

Dizziness or a disturbed sense of balance may affect the performance of skilled tasks such as driving. Effects may occur and persist up to several months after stopping mefloquine.

Question 23

How much quinine bisulphate is equivalent to 100mg of quinine base?

Answer 23

169mg.

Question 24

How much quinine dihydrochloride is equivalent to 100mg of quinine base?

Answer 24

122mg.

Question 25

How much quinine hydrochloride is equivalent to 100mg quinine base?

Answer 25

122mg.

Question 26

How much quinine sulphate is equivalent to 100mg quinine base?

Answer 26

121mg.

Question 27

When using quinine for malaria prophylaxis, what salts are doses equivalent for?

Answer 27

Dihydrochloride, hydrochloride, sulphate.