Quinine with tetracycline

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. 

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. 

A study in patients with acute falciparum malaria found that quinine levels were about doubled in those taking quinine 600 mg every 8 hours with tetracycline 250 mg every 6 hours, when compared with those taking quinine alone. Quinine levels were above the MIC for malaria with the combination but not for quinine alone. Two of 8 patients treated with quinine alone had malaria recrudescence (the reappearance of the disease after a period of inactivity) compared with none of 8 patients receiving the combination. In vitro tetracycline is also a potent inhibitor of quinine metabolism. The authors considered that this pharmacokinetic interaction might be part of the explanation why the combination has been found to be more effective. ... 

Karbwang J, Molunto P, Bunnag D, Harinasuta T. Plasma quinine levels in patients with falciparum malaria given alone or in combination with tetracycline with or without primaquine. Southeast Asian J Trap MedPtAUc Health ( 99 ) 22, 72-6. 

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. 

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

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. 

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. 

Malaria is still one of the most prevalent protozoan diseases in the world. The mosquito infects the human and the parasite passes through two phases. The tissue phase causes no clinical symptoms in the human and the erythrocytic phase invades red blood cells and causes chills, fever, and sweating. In the United States the 1000 cases reported annually are almost all from international travel. Quinine was the only antimalarial drug from 1820 to the early 1940s when synthetic antimalarial drugs were developed. Chloroquine is commonly prescribed. If drug resistance develops quinine is used in combination with an antibiotic such as tetracycline. 

Pyrimethamine/sulfadoxine and tetracycline have been shown to increase halofantrine levels, and may therefore increase its toxicity. Diltiazem, erythromycin, ketoconazole, mefloquine, quinine, and quinidine might also increase the toxicity of halofantrine because they have been shown to inhibit its metabolism in vitro. The manufacturer has therefore recommended caution with the concurrent use of potent CYP3A4 inhibitors. Fatty food markedly increases halofantrine levels, consequently it is recommended that halofantrine is taken on an empty stomach. Grapefruit juice has a similar effect Note that halofantrine is no longer widely marketed. 

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