Tetracycline Quinine

Quinine-tetracycline. In infections produced by chloroquinine-resistant P. falciparum. 

Doxycycline does not appear to alter the pharmacokinetics of quinine. Tetracycline increases quinine levels and has been found to improve efficacy. 

Upon oral administration, quinine effectively acts in combination with pyrimethamine, sulfadiazine, and/or tetracycline for treating uncomplicated incidents of chloroquine-resistant forms of P. falciparum. Because of the many associated side effects, its use is extremely limited. Currently, the only indication for use is for forms of malaria that are resistant to other synthetic drugs. Synonyms of this drug are bronchopulmin, nicopriv, quinnam, and others. 

VLa.2,6. Other antimalarials. Doxycydine (see Section ILb) is a useful and effective short-term prophylactic agent for travellers to chloroquine-resistant areas and can be used as an alternative when mefloquine or proguanil is unavailable or mefloquine is contraindicated. In combination with quinine also tetracycline is used as an antimalarial. 

Drugs that inhibit platelet function (e.g., aspirin) or produce thrombocytopenia increase the risk of bleeding when heparin is administered. Oral anticoagulants and heparin produce synergistic effects. Many basic drugs precipitate in the presence of the highly acidic heparin (e.g., antihistamines, quinidine, quinine, phenothiazines, tetracycline, gentamicin, neomycin). 

Doxycycline Tetracycline Treatment (with quinine) of infections with P falciparum chemoprophylaxis... 

Chloroquine-resistant Quinine Artemisinin derivatives Atovaquone-proguanil Mefloquine Pyrimethamine-sulfadoxine Antibacterials (e.g., clindamycin, doxycycline, sulfamethoxazole, or tetracycline] ... 

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. 

The choice of the mobile phase is very important, as fluorescence is sensitive to fluorescence quenchers. Highly polar solvents, buffers, and halide ions quench fluorescence. The pH of the mobile phase is also important to fluorescence efficiency for example, quinine and quinidine only display fluorescence in strongly acidic conditions, whereas oxybarbiturates are only fluorescent in a strongly alkaline solution [67,68]. Due to the stability of the chromatographic sorbents, the use of very acidic or basic mobile phase may not be possible. One alternative is to alter the effluent pH postcolumn. Postcolumn addition of sulfuric acid has been used for the assay of ethynodiol diacetate and mestranol in tablets [69]. Another example is the determination of tetracycline antibiotics in capsules and syrup where EDTA and calcium chloride were added to enhance fluorescence [70]. 

PORFIMER I. ACE INHIBITORS -enalapril 2. ANALGESICS -celecoxib, ibuprofen, ketoprofen, naproxen 3. ANTIARRHYTHMICS — amiodarone 4. ANTIBIOTICS -ciprofloxacin, dapsone, sulphonamides, tetracyclines 5. ANTICANCER AND IMMUNOMODULATING DRUGS -fluorouracil (topical and oral) 6. ANTIDIABETIC DRUGS-glipizide 7. ANTIMALARIALS -hydroxychloroquine, quinine 8. ANTIPSYCHOTICS -chlorpromazine, fluphenazine 9. CALCIUM CHANNEL BLOCKERS - diltiazem 10. DIURETICS -bumetanide, furosemide, hydrochlorothiazide II. PARA-AMINOBENZOIC ACID (TOPICAL) 12. RETINOIDS-acitretin, isotretinoin 13. SALICYLATES (TOPICAL) t risk of photosensitivity reactions Attributed to additive effects Avoid exposure of skin and eyes to direct sunlight for 30 days after porfimer therapy... 

Bind to other drugs that are administered within 1 or 2 hours of the antacid, This process results in reduced availability of the co-administered drug for absorption, For example, the chelation of tetracyclines (e.g, tetracycline, doxycycline) will decrease their absorption by up to 90%, Avery similar process - precipitation - occurs with drugs such as quinine with aluminium and magnesium hydroxide preparations, which results in a decreased absorption of quinine, It has to be noted that the absorption of fluoroquinolones (e g. ciprofloxacin, norfloxacin, ofloxacin, enoxacin, perfloxacin i will be decreased by 60-75% if they are co-administered with divalent and trivalent cations. Patients are recommended not to take these divalent and trivalent cationic preparations until fluoroquinolone therapy is discontinued. 

Chloroquine, quinine, mefloquine, halofantrine, proguanil, pyrimethamine, and tetracyclines blood schizontocides) kill these asexual forms. Drugs which act on this stage in the cycle of the parasite may be used for ... 

Fixed eruptions are eruptions that recur at the same site, often circumoral, with each administration of the drug e.g. phenolphthalein (laxative self-medication), sulphonamides, quinine (in tonic water), tetracycline, barbiturates, naproxen, nifedipine. 

In a comparison between oral artesunate (700 mg over 5 days) plus tetracycline (250 mg at 6-hour intervals) and quinine (600 mg quinine sulfate at 8-hour intervals) for 7 days, artesunate was more effective and better tolerated in uncomplicated malaria (see Table 2) (18). Convulsions occurred in one case. 

Table 2 Adverse effects in a comparison of artesunate plus tetracycline versus quinine...

Karbwang J, Na-Bangchang K, Thanavibul A, Bunnag D, Chongsuphajaisiddhi T, Harinasuta T. Comparison of oral artesunate and quinine plus tetracycline in acute uncomplicated falciparum malaria. Bull World Health Organ 1994 72(2) 233-8. 

Common causes of fixed eruptions are ampicillin, aspirin, barbiturates, dapsone, metronidazole, NSAIDs, oral contraceptives, phenolphthalein, phenytoin, quinine, sulfonamides, and tetracyclines. 

Quinine (650 mg every 8 honrs for 5 to 7 days) is indicated for the treatment of chloroquine-resistant falciparum malaria, either alone, with pyrimethamine and a sulfonamide, or with a tetracycline. It is also considered as an alternative therapy for chloroquine-sensitive strains of P. falciparum, P. malariae, P. ovale, andP vivax. Mefloquine and clindamycin may also be nsed with quinine, depending on the geographical location in which the malaria was acquired. 

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