Malaria acute attack

A combination of pyrimethamine, sulfonamide, and qninine is the dmg of choice for acute attacks of malaria and its chloroquine-resistant forms. 

Malaria For the suppressive treatment and treatment of acute attacks of malaria caused by Plasmodium vivax, P. malariae, P. ovale, and susceptible strains of P. falciparum. 

P vivax malaria is the most prevalent type of infection and is characterized by periodic acute attacks of chills and fever, profuse sweating, enlarged spleen and liver, anemia, abdominal pain, headaches, and lethargy. Hyperactivity of the reticuloendothelial system and hemolysis are the principal causes of the enlarged spleen and liver these effects often result in anemia, leukopenia, thrombocytopenia, and hyperbilirubinemia. The cyclical nature of the acute attacks (48 hours for... 

In areas where chloroquine-resistant P. falciparum is common, a combination of a rapidly acting blood schi-zonticide and pyrimethamine-sulfadoxine may be the treatment of choice. An acute attack of malaria caused... 

It is indicated in acute attack of multidrug resistant P. falciparum malaria where quinine is not effective. 

C. It is the drug of choice for the treatment of an acute attack of falciparum or vivax malaria. 

Dose. For an acute attack of malaria, 2 g of hydroxychloroquine sulphate given over three days (1.2 g on the first dayX In rheumatoid arthritis, initially 400 to 800 mg daily. 

Pyrimethamine acts synergistically with suifadoxine (as Fansidar) to inhibit folic acid metabolism (see antifols, above) suifadoxine is excreted in the urine. The combination is chiefly used with quinine to treat acute attacks of malaria caused by susceptible strains of Plasmodium falciparum a single dose of pyrimethamine 75 mg plus suifadoxine 1.5 g (3 tablets) usually suffices. 

P. falciparum This specie.s is estimated to cause approximately 50% of all malaria. It causes the most. severe form and the most debilitating form of the disease, because patients feel ill between acute attacks. One reason why it leaves the patient so weak is that it infects up to 65% of the patient s erythrocyte.s. 

Malaria. Transient hepatic dysfunction commonly occurs in childhood malaria (P6). Patwari et al. (P6), who studied a group of 80 children with Plasmodium vivax malaria, claimed that serum alkaline phosphatase values were elevated in 46% of patients during the acute attack, with a return to normal within the ensuing 6 weeks. While several abnormalities of liver function have been reported in adult patients with malaria, hyperphosphatasemia has only rarely been observed (G16). Among 81 patients with either falciparum or vivax malaria studied by... 

Hydroxychloroquine sulfate is a 4-aminoquinoline compound that interferes with parasitic nucleoprotein (DNA/ RNA) synthesis and parasite growth or causes lysis of parasite or infected erythrocytes. In rheumatoid arthritis, it may suppress formation of antigens responsible for symptom-producing hypersensitivity reactions. It is indicated for prophylaxis and treatment of acute attacks of malaria caused by Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale, and susceptible strains of Plasmodium falciparum. It is also used for treatment of chronic discoid and systemic lupus erythematosus (SLE) and acute or chronic rheumatoid arthritis in patients not responding to other therapies. 

THERAPEUTIC USES Chloroquine is inexpensive and safe, but its usefulness has dechned in those parts of the world where strains of P. falciparum are resistant. Except in areas where resistant strains of P. vivax are reported (Table 39-2), chloroquine is very effective in prophylaxis or treatment of acute attacks of malaria caused by P. vivax, P. ovale, and P. malariae. Chloroquine has no activity against primary or latent liver stages of the parasite. To prevent relapses in P. vivax and... 

Clinical use Chloroquine is the drug of choice for acute attacks of nonfalciparum and sensitive falciparum malaria and as a chemosuppressant, except in regions where P falciparum is resistant. The drug is solely a blood schizonticide and will not eradicate secondary tissue scbizonts. Chloroquine has been used in amebic liver disease in combination with metronidazole and in autoimmune disorders including rheumatoid arthritis. 

Clinical use Primaquine is used to eradicate liver stages of P vivax and P ovale and should be used in conjunction with a blood schizonticide. Though not active alone in acute attacks of vivax and ovale malaria, a 14-day course of primaquine is standard following initial treatment with chloroquine. 

Which of the following drugs should be used for oral treatment of the photographer s acute attack of P vivax malaria ... 

Chloroquine is the drug of choice for the oral treatment of an acute attack of malaria due to P vivax but will not eradicate exoerythrocytic forms of the parasite. Quinine or quinidine is used for the parenteral treatment of acute attacks. The answer is (A). 

Quinine sulfate is the standard drug for oral treatment of acute attacks of malaria due to chloroquine-resistant P falciparum. It should be used in combination with one or more other antimalarial drugs such as doxycycUne, clindamycin, or pyrimethamine plus sulfadiazine. The answer is (E). 

Pyrimethamine Inhibits folate synthesis by interfering with dihydrofolate reductase. Malaria prophylaxis. Erythrocytic form of P. falciparum. Used in combination with sulfonamides or sulfones for acute attacks. 

Chloroquine is an excellent suppressive agent for treating acute attacks of malaria caused by Plasmodium vivax and Plasmodium ovale. The drug also is effective for cure and as a suppressive prophylactic for the treatment of Plasmodium malariae and susceptible Plasmodium falciparum. 

In an uncomplicated attack of malaria (for all plasmodia except chloroquine-resistant P. falciparum and P. vivax), the recommended regimen is chloroquine 600 mg (base) initially, followed by 300 mg (base) 6 hours later, and then 300 mg (base) daily for 2 days.3 In severe illness or falciparum malaria, patients should be admitted to an acute care unit and quinidine gluconate 10 mgsalt/kg... 

Clinical Use. Primaquine is typically used to treat the relapses of specific forms of malaria,12 and is generally administered in acute or severe exacerbations, or when other drugs (chloroquine, mefloquine) are ineffective in suppressing malarial attacks. Primaquine may also be used to prevent the onset of malaria in individuals who are especially at risk because of prolonged exposure to the disease.50 This drug is administered orally. 

Note The main objective in the clinical management of patients suffering from an acute malaria attack is the prompt elimination of the parasite form responsible for the symptoms, that is, the asexual erythrocytic form. Drugs that are particularly effective in this regard are called schizontocidal or suppressive agents. They include such compounds as amodiaquine, chloroguanide, chloroquine, hydroxychloroquine, pyrimethamine, quinine, and tetracycline. 

Quinacrine and its congeners display substantia] activity against the asexual erythrocytic forms of plasmodia that cause human malaria, but they are neither causally prophylactic nor radically curative and have no action on the gametocytes. The acridines are therefore used for suppressive therapy and they resemble the 4-aminoquinolines and quinine in this respect quinacrine is less toxic and more elfective than quinine but more toxic and less effective than chloroquine. The recommended regimen for quinacrine to terminate acute malarial attacks is 2800 mg given over seven days, with initial administration of five loading doses of 200 mg every six hours to... 

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