Adult dose Pediatric dose Comments Contraindications/ Precautions
travel, then daily and for 7 with severe renal impairment
should be taken with food women, and women
only in areas chloroquine- sensitive P. falciparum
retinopathy not seen in malaria prophy doses
same day of the until for 4 SE: gastrointestinal
only in areas chloroquine- sensitive P. falciparum
avoid esophagitis. Common SE—GI upset (take with food and full glass of water to minimize), sun sensitivity, increased frequency of Candida vaginitis in women
≤9 kg: 4.6 mg/kg base Begin 1-2 weeks before
gastrointestinal disturbance, headache, insomnia, abnormal dreams, visual disturbances, depression, anxiety disorder, and dizziness Rare SE: sensory and motor neuropathies (parasthesia, tremor, and ataxia), agitation or restlessness, mood changes, panic attacks, forgetfulness, confusion, hallucinations, aggression, paranoia, and encephalopathy
*Mefloquine-resistant P. falciparum is present in eastern Burma (states of Shah, Kayin, and Kayah), the western provinces of Cambodia that border Thailand, and all malaria-risk areas in Thailand. **Travelers who start with medications such as mefloquine or doxycycline but must switch to atovaquone/proguanil during or after travel should continue their atovaquone/proguanil for 4 weeks after switching or 1 week after returning, whichever is longer, but not beyond 4 weeks after return. ***Recommendations in pregnancy: Avoid travel to malarious area if possible. If Chloroquine-sensitive area, use chloroquine. If chloroquine-resistant, use mefloquine (2nd and 3rd trimesters, probably ok in 1st but limited data.) Malarone not recommended— insufficient data; doxycycline contraindicated, primaquine contraindicated due to risk if G6PD deficient fetus.
*** Recommendations with breastfeeding: Very small amounts of chloroquine and mefloquine are excreted in breast milk; the amount of drug is not sufficient to harm the infant nor is the quantity sufficient to protect the child from malaria. Breastfeeding infants should receive the recommended dosages of antimalarials found in the table above. Very limited data are available on the use of doxycycline in lactating women; most experts consider the theoretical possibility of adverse events to be remote. Primaquine should only be given to lactating women if both the woman and her infant have been tested for G6PD deficiency and have documented normal G6PD levels. Because safety data is not yet available, atovaquone/proguanil is not currently recommended for women breastfeeding infants <11kg.
Study Questions: For each patient, which medication(s) are contraindicated, inappropriate or “inferior” choices and why:
1. A healthy 45 year old man returning to eastern Burma to visit friends and relatives. 2. A 66 y/o Veteran with DM, seizure disorder, and ASCVD with an AICD for history of Vtach going
on a church work and witness trip to Belize.
3. A 33 y/o female with lupus and ESKD on peritoneal dialysis returning to Ecuador for six months to
4. A 21 y/o female college student on sertraline for significant depression with red hair and fair skin
planning 6 month internship in wildlife management in a game park in Tanzania.
MALARIA AND HOMEOPATHIC REMEDIES IN GHANA An Open Study and a Double-Blind Randomized Clinical Trial V.M.A. van ERP 1 and M. BRANDS 2 1 BSc, Vrije Universiteit Amsterdam 2 MD, Homeopaths without Borders Netherlands 1. Introduction Malaria is a disease caused by four parasites: Plasmodium falciparum , P vivax , P. ovale and P. malariae . Each of them has its own morphological