CDC Other oral options include atovaquone-proguanil

(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.