(Malarone ®), quinine, or mefloquine. Because of a higher risk of
severe neuropsychatric adverse events at treatment doses, mefloquine should
only be used if the other antimalarials are not available. Since IV artesunate
is neither FDA approved nor commercially available in the United States,
hospitals cannot purchase and keep it in stock. Although it increases the
parasite resistance, it is still regarded as one of the most commonly
antimalarial drugs, –. Healthcare providers will need to decide the most
feasible alternative to administer oral medicines while awaiting IV artesunate.
For example, if this intolerance is due to nausea and vomiting, an anti-emetic
preceding the antimalarial may help, and, for comatose patients, a nasogastric
tube can be considered. Of note, exclusive use of IV or oral clindamycin and
tetracyclines, such as doxycycline, is not recommended. Artemether/lumefantrine
(Coartem ®) is the preferred antimalarial for interim treatment because of its
fast onset of action.
These
drugs are slow-acting antimalarials that would not take effect until well after
24
hours and are not effective
antimalarials for treatment of severe malaria when used alone.
Outside these hours, providers
should call and ask to speak with the CDC Malaria Branch clinician on call.
Chloroquine-induced pruritus has been described as a biting
or stinging sensation which occurs after some hours of chloroquine
administration irrespective of the route of administration.
Read more about why not check
herehere.
What should I do if I forget a dose?
Reports of emergence of resistance
of Plasmodium falciparum to chloroquine in the tropics presents a serious and
urgent problem in the prevention and treatment of malaria with chloroquine.
Furthermore, it has been reported that 1 out of every 2 persons in the tropics
itch with varying degree to the use of chloroquine, which resulted in
discontinuation of treatment. Treatment failures
associated with the use of chloroquine may not necessarily be as a result of
the emergence of resistance but more likely due to non-compliance as a result
of pruritus. Several studies on the possible factors responsible for
chloroquine-induced pruritus have been documented.
As an alternative, CDC has made
IV artesunate available through an expanded-use investigational new drug (IND)
protocol, an FDA regulatory mechanism, to provide this lifesaving treatment to
patients with severe malaria. Although chloroquine is an antimalarial, it is
often not sufficient for prophylaxis. Chloroquine used to be the antimalarial
of choice and it was widely used for from 1947 onwards. This review evaluates
some of such factors, the possible mechanism by which the pruritus is induced
as well as the efforts so far made to manage it and the overall impact on
management of malaria with chloroquine. The first report due to quinine
resistance in mice was presented by Thompson et al in 1965. Quinine alone or
with other antimalarial medications is used to treat malaria cases especially
in pregnant women near delivery. Of course, the presence of Plasmodium
falciparum (P. falciparum) has been reported even after treatment with quinine
in humans.