Malaria prophylaxis

Malaria prophylaxis (except Adoxa, Doryx, Monodox) Begin prophylaxis 1 to 2 days prior to travel to an endemic area, continue during travel and for 4 weeks after returning from travel. 

Thus far no major adverse effects have been reported for artemisinin and its derivatives. Although neurotoxicity can occur in animals, it has never been reported in humans. However, subclinical cumulative neurotoxicity could occur with each treatment course for separate episodes of malaria. This possible risk prohibits the use of artemisinin drugs for malaria prophylaxis. 

Unlabeled Uses Demodicidosis, insect bite prophylaxis, leishmaniasis prophylaxis, malaria prophylaxis... 

Malaria prophylaxis PO 30 mgbase daily. Begin 1 daybefore departure and continue for 7 days after leaving malarious area. 

Doxycydine (Adoxa, Periostal-, Oracea, Vibramycin, Vibra-Tabs) [Anribiotic/Tetracycline] Uses Broad-spectrum antibiotic acne vulgaris, uncomplicated GC, Chlamydia sp, PID, Lyme Dz, skin Infxns, anthrax, malaria prophylaxis Action Tetracycline bacteriostatic X- protein synth Dose Adults. 100 mg PO ql2h on 1st d, then 100 mg PO daily bid or 100 mg IV ql2h acne daily dosing, Chlamydia 7d, Lyme Dz 14—21 d, PID 14 d Peds >8 y 5 mg/kg/24 h PO, to a max of 200 mg/d - daily-bid Caution [D, +] Hepatic impair Contra Children <8 y, severe hepatic dysfxn Disp Tabs, caps, syrup, susp, inj SE D, GI disturbance, photosens Interactions T Effects OF digoxin, warfarin 1 effects W/ antacids, Fe, barbiturates, carbamazepine, phenytoins, food 4-effects OF penicillins EMS Monitor for signs of electrolyte disturbances and hypovolemia d/t D monitor for S/Sxs of super Infxn T risk of photosensitivity Rxns antibiotic of choice for the Tx and prophylaxis of anthrax exposure expired tetracyclines have been known to cause nephrotox OD May cause adverse GI effects symptomatic and supportive... 

Skjelbo E, Mutabingwa TK, Bygbjerg I, et al. Chloro-guanide metabolism in relation to the efficacy in malaria prophylaxis and the 5-mephenytoin oxidation in Tanzanians. Clin Pharmacol Ther 1996 59 304-311. 

A 48-year-old woman developed anxiety, tremor, depression, dry mouth, nausea, and marked weight loss (503). Physical examination, electrocardiography, chest X-ray, CT scan, and laboratory investigations were unremarkable. The Hamilton D score was 44 for 17 items. She had taken mefloquine 250 mg/week for 8 weeks for malaria prophylaxis, and after 2 weeks had started to feel unwell, with dysphoria, depression, and weakness. She was given fluoxetine 20 mg/day and alprazolam 1.5 mg/day. Her condition continued to deteriorate. The dose of fluoxetine was increased to 40 mg/day and flunitrazepam was added. She was later instead given milnacipran, a serotonin and noradrenaline reuptake... 

After 4 weeks of malaria prophylaxis with mefloquine 250 mg/week, a 25-year-old woman developed bizarre... 

Chloroquine and hydroxychloroquine are quinoline drugs used for the chronic management of rheumatoid arthritis, discoid and systemic lupus erythematosus, and other collagen diseases. Because chloroquine is rapidly absorbed and becomes highly concentrated in various tissues due to melanin and protein binding, it is now used only for malaria prophylaxis. Hydroxychloroquine has replaced it primarily because of its superior safety profile. 

The principal reason against recommending amodiaquine for malaria prophylaxis is the reporting of agranulocytosis, occasionally associated with hepatitis (SEDA-12, 241) (SED-12, 692). Since specific IgG antibodies, which lead to leukopenia, can be detected, aU this suggests that the agranulocytosis is immune-mediated. 

Lell B, Luckner D, Ndjave M, Scott T, Kremsner PG. Randomised placebo-controlled study of atovaquone plus proguanil for malaria prophylaxis in children. Lancet 1998 351(9104) 709-13. 

Anonymous. Atovaquone -f proguanil for malaria prophylaxis. Drug Ther Bull 2001 39(10) 73-5. 

BertagnoUo S, TacconeUi E, CamiUi G, TumbareUo M. Case report retinopathy after malaria prophylaxis with chloro-quine. Am J Trop Med Hyg 2001 65(5) 637-8. 

GeeUioed DW, Visser LE, Addae V, Asare K, Schagen van Leeuwen JH, van Roosmalen J. Malaria prophylaxis and the reduction of anemia at childbirth. Int J Gynaecol Obstet 2001 74(2) 133-8. 

Acute fatty liver has recently been reported after malaria prophylaxis with mefloquine (34). 

Lobel HO, Bernard KW, Williams SL, Hightower AW, Patchen LC, Campbell CC. Effectiveness and tolerance of long-term malaria prophylaxis with mefloquine. Need for a better dosing regimen. JAMA 1991 265(3) 361. ... 

Overbosch D, Schilthuis H, Bienzle U, Behrens RH, Kain KC, Clarke PD, Toovey S, Knobloch J, Nothdurft HD, Shaw D, Roskell NS, Chulay JD Malarone International Study Team. Atovaquone-proguanil versus mefloquine for malaria prophylaxis in nonimmune travelers results from a randomized, double-blind study. Clin Infect Dis 200I 33(7) 1015-21. 

Proguanil is one of the antimalarial drugs most widely used for prophylactic purposes, usually in combination with chloroquine or atovaquone in malaria prophylaxis, and with atovaquone in malaria treatment (SEDA-21, 297). A biguanide, it is rapidly absorbed in standard doses and mainly excreted by the kidneys. Its antimalarial effect is due to its metabolite cycloguanU. However, its metabolism varies individually, and this is reflected in a variable degree of efficacy (SEDA-17, 328). 

Three patients developed a hypersensitivity syndrome after taking pyrimethamine 12.5 mg + dapsone 100 mg weekly as malaria prophylaxis (16). The diagnosis was based on the presence of fever, lymphadenopathy, a maculopapular rash, and hepatitis. A mild Coombs -positive hemolytic anemia was also observed in one of the patients. All the clinical, hematological, and biochemical abnormalities normalized within 3 months of tapering regimens of moderate-dose prednisolone. 

Pulmonary reactions have been described with most sulfonamides. Pyrimethamine -I- sulfadoxine, used in malaria prophylaxis and treatment, also rarely causes pulmonary reactions (17-19). The sulfapyridine moiety of sulfasalazine, used in inflammatory bowel disease, can produce adverse pulmonary reactions (20). 

Miller KD, Lobel HO, Satriale RF, Kuritsky JN, Stern R, Campbell CC. Severe cutaneous reactions among American travelers using pyrimethamine-sulfadoxine (Fansidar) for malaria prophylaxis. Am J Trop Med Hyg 1986 35(3) 451-8. 

In 104 healthy men (mean age 29 years, weight 60 kg) who took tafenoquine for malaria prophylaxis (loading dose 400 mg/day for 3 days followed by 400 mg/month in 5 consecutive months) age and weight affected the apparent volume of distribution, and subjects who contracted malaria had higher clearance rates (3). The population estimate of the first-order absorption half-life was 1.0 hour, clearance was 3.20 1/hour, volume of distribution was 1820 liters, and half-life was 16.4 days. 

Indications Malaria prophylaxis and treatment Category Antimalarial Half-life 24 hours... 

Mefloquine Consider alternate form of malaria prophylaxis. 

All three vaccine preparations may be administered for preexposure prophylaxis as a three-dose series of 1 mL IM on days 0 and 7 and once between days 21 and 28. Alternatively, HDCV can be administered intradermally in a dose of 0.1 mL using the same schedule. HDCV must be given using the specific intradermal dosage form and syringe. Lower rabies antibody concentrations have been observed in individuals immunized using the intradermal route while taking malaria prophylaxis concurrently. The IM route is recommended in this situation. ... 

These dmgs prevent infection of red blood cells. Treatment should begin one or two weeks before travelling to areas where malaria is endemic and be continued for at least four weeks after returning. No form of malaria prophylaxis is completely effective and other precautions should be taken. However, should an infection occur the symptoms are usually less severe. 

Some in vitro studies have demonstrated that azithromycin is active against chloroquine-sensitive and -resistant strains of Plasmodium falciparum [285]. A trial using daily azithromycin at a dose of 250 mg as a malaria prophylaxis in volunteers has shown azithromycin to be protective against P. falciparum challenge [286,287]. A randomized, placebo-controlled, double-blind study of malaria prophylaxis compared two regimens of azithromycin versus daily doxycycline for a period of 10 weeks in western Kenya [287]. Both regimens with daily azithromycin and doxycycline provided effective prophylaxis of falciparum malaria in this trial. A potential advantage of azithromycin over doxycycline for malaria prophylaxis is... 

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