Malaria

Question 1

When should you avoid malaria?

Answer 1

Asplenic + pregnant

Question 2

What are the symptoms of malaria?

Answer 2

• High temp >38
• Chills
• Headache
• Muscle aches
• Di + vom

Question 3

What is used for bite prevention?

Answer 3

• Personal protection (Counsel: warn about importance of avoiding mosquito bites)
• Net impregnated w permethrin
• DEET 20-50% 2M (apply sunscreen first)
• Long sleeves + trousers after dusk

Question 4

What drugs are used for chemoprophylaxis?

Answer 4

Chloroquine
- MHRA: chloroquine: psychiatric reactions

Chloroquine + proguanil

Doxycycline 12+
- Counsel: 100mg OD: take 1-2 before entering endemic area + continue for 4 weeks after leaving

Malarone

Mefloquine
- Counsel: report new or worsening mental health symptoms, be careful when driving

Question 5

Which drugs do you avoid in epilepsy?

Answer 5

Avoid chloroquine + mefloquine

Question 6

Which drugs do you avoid in renal impairment?

Answer 6

• Avoid proguanil
• Malarone eGFR <30

Question 7

Which drugs do you take when pregnant?

Answer 7

• Chloroquine + proguanil (5mg folic acid daily)
• Doxycycline CI

Question 8

How do you take malaria prophylaxis when taking warfarin?

Answer 8

• Start 2-3 weeks before travel
• Stable INR: monitor before, 7 days after start + completion

Question 9

What is the treatment after being dianosed with malaria?

Answer 9

Standby treatment eg quinine
- Access to medical care 24+H away
- Written instructions: if fever >38 for 7+ days - urgent care

Any illness w/in 1 year/3 months of return
- Counsel: promptly see doctor if any illness + mention malaria exposure

Question 10

Regimes: malarone

Answer 10

• Before travel: 1-2 days
• After travel: 1 week
• LT use: 1 year
• Avoid: severe RI
• How to take: OD

Question 11

Regimes: doxycycline

Answer 11

• Before travel: 1-2 days
• After travel: 4 week
• LT use: 2 year
• Side effect: photosensitive, esophageal irritation
• Avoid: pregnancy + breast feeding, under 12
• How to take: OD

Question 12

Regimes: mefloquine

Answer 12

• Before travel: 2-3 weeks
• After travel: 4 week
• LT use: 1 year
• Side effect: psychiatric reactions
• Avoid: epilepsy
• How to take: once weekly

Question 13

Regimes: proguanil

Answer 13

• Before travel: 1 week
• After travel: 4 week
• Avoid: RI
• How to take: OD

Question 14

Regimes: chloroquine

Answer 14

• Before travel: 1 week
• After travel: 4 week
• Side effect: psychiatric reactions
• Avoid: epilepsy, severe RI
• How to take: once weekly

Question 15

Regimes: chloroquine + proguanil

Answer 15

• Before travel: 1 week
• After travel: 4 week
• Side effect: psychiatric reactions
• Avoid: epilepsy, RI