Malaria - mefloquine or other tx in Africa? - apple09

[ArchivalUser]

If someone gets malaria in Africa, do you treat with mefloquine or something else? I know that region in Africa is mainly chloroquine resistant, but I thought mefloquine is just a prophylaxis and not actual treatment. Does mefloquine work as treatment too?

[ArchivalUser]

FOR UNCOMPLICATED P.FALCIPARUM MALARIA:

Use ACTs (artemisinin-combination therapies)...for 3 to 7 days

1st line is DHA + Piperquine ( worldwide)

For Africa, you can use artesunate + amodiaquine

In East Asia ( Multidrug resistant): you can use artemether+ lumefantrine or artesunate + Mefloquine




FOR UNCOMPLICATED P.FALCIPARUM MALARIA IN PREGNANT:

1st Trimester: Quinine + Clindamycin for 7 days or Artesunate + Clindamycin for treatment failures.

2nd/ 3rd Trimesters: ACTs as per Uncomplicated P. faclciparum or the same as bove for 1st trimester.




FOR UNCOMPLICATED MALARIA IN LACTATING WOMEN:
Can use anything as above except Primaquine and Tetracycline.




FOR UNCOMPLICATED P.FALCIPARUM MALARIA IN INFANTS:
ACTs




FOR SEVERE P.FALCIPARUM MALARIA:
i.v/ i.m artesunate


FOR TRAVELLERS RETURNING TO NON- ENDEMIC COUNTRIES:

Atovaquone + Proguanil
or
artemether+ lumefantrine


FOR UNCOMPLICATED P.FALCIPARUM MALARIA IN HIV INFECTED PTS:

Rx as the same above ( Uncomplicated P.Falciparum Malaria)
DON'T USE AMODIAQUINE containing ACTs if the pt is on Zidu or Efarivenez

FOR UNCOMPLICATED P.VIVAX:

Chloroquine Sensistive: Chloroquine + Primaquine ; Increase the dose of Primaquine if they reside in SE Asia or Oceania countries...

For Chloroquine Resistant: Use ACT + Primaquine

If Mild- Mod G6PD Deficient cases: Reduce Primaquine Doses
In Severe G6PD Deficient cases: Don't Use Primaquine.

[ArchivalUser]

Chapper...nice for sharing


But I am wondering...quinine ...for uncomplicated malaria in first trimester. It can cause abortion, right?

[ArchivalUser]

Chapper,...where did you get above info...

Quinine can be used in pregnancy only in complicated cerebral malaria before, but now rarely used it because of artesunate and artemether...
We use primaquine and chloroquine.

Please share u opinion.

[ArchivalUser]

@ forever..there is a general belief that it is an abortifacient...but it is the 1st line of treatment for Malaria in pregnant women in 1st trimester....primaquine is contraindicated but as far as I know...the only thing that is an adverse affect seen in pregnant women on quinine is severe hypoglycemia due to increased insulin sensitivity....

[ArchivalUser]

ACTs are used as a second line agent in uncomplicated P.Falciparum Malaria in 1st trimester pregnant women...it is only used if this is the only treatment immediately available, or if treatment with 7-day quinine plus clindamycin fails, or if there is uncertainty about patient compliance with a 7-day treatment...

[ArchivalUser]

http://www.rcog.org.uk/files/rcog-corp/G...cy0810.pdf

Yes, severe falciparum malaria...artesunate is first, if not available, quinine
Vivax... Chloroquine

Uncomplicated malaria....Quinine plus clinda

Primaquine is contraindicated.

Nice , chapper, thanks