Malaria Treatment Flashcards
What do you use to treat severe falciparum?
IV quinidine+doxy
ACT (artesunate+mefloquine)
What do you use to treat vivax and ovale?
Chloroquine+ primaquine
What do you use to treat uncomplicated falciparum? in order of what you would try
ACT: Artemether+lumefantrine
Malarone
Quinine+doxy
Chloroquine
Used to be amazing: fast, safe, few side effect, cheap
Now too much resistance
What drugs act at blood stage?
Chloroquine
Quinine
Mefloquine
Sulfadoxine-pyrimethamine
Artemisinins
What acts at liver stage?
Primaquine **its the only one
Tissue schizontoid, asexual blood stages for vivax not falciparum only
gametocide
Helps prevent relapse
Long regimen– 2 weeks
If you have G6PD deficiency - massive hemolysis
*This is bad bc it’s one of the polymorphisms that protects you from severe disease
What do artemisinins do?
Act at blood stage on both schizonts and gametocytocides
Potent, rapid action, no resistance
Expensive, short half life, must be used in combination
Quinine/quinidine
Great drug for severe malaria
Hits trophozoites of all & gametocytes of ovale, malariae, vivax
SE include worsening of hypoglycemia, long Qt, hypotension, hearing loss
Mefloquine
Used in ACT
Resistance is common
Travelers prophylaxis
SE: GI, neuropsychiatric, rarely pneumonitis (women)
What is ACT?
Artesunate or artemether + one of the following:
- mefloquine, lumefantrine
- amodiaquine, malarone, SP
- piperaquine
Artesunate-mefloquine is effective even though there’s mefloquine resistance
Most effective, fastest regiemnt, reduces gametocytes
Expensive and increased pill burden, short half life
What’s the best prophylaxis for Malaria?
Malarone (Atovaquone-proguanil): best tolerated, prevents blood and liver stages, expensive, lots of pills, 1 week treatment
Mefloquine: nightmares, weekly dosing, resistance in Asia
Doxy: take daily, cheap, not for kids <8, GI upset, photosensitivity
When you take prophylaxis, what are you preventing?
Severe illness due to infection
You don’t prevent infection by parasite, because they target the blood stage (which means you can still get the liver stage)
You have to take it before, during, and after traveling to an endemic region because of this
