occur. Injection should befiltered immediately before
administration using afilter of 5 microns or less.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Pentostam(GlaxoSmithKline UK Ltd)
Antimony pentavalent (as Sodium stibogluconate) 100 mg per
1mlPentostam 10 g/ 100 ml solution for injection vials| 1 vialP
£ 66. 435.2 Malaria
Antimalarials 23-Jan-2018
Artemether with lumefantrine
Artemether with lumefantrine p. 393 is licensed for the
treatment of acute non-complicated falciparum malaria.Chloroquine
Chloroquine p. 395 is used for theprophylaxis of malariain
areas of the world where therisk of chloroquine-resistant
falciparum malaria is still low. It is also used with proguanil
hydrochloride p. 397 when chloroquine-resistant falciparum
malaria is present but this regimen may not give optimal
protection (for details, see Recommended regimens for
prophylaxis against malaria p. 387 ).
Guidelines for malaria prevention in travellers from the
United Kingdom ( 2017 ) published by Public Health England
state that patients already taking hydroxychloroquine
sulfate p. 639 for another indication, and for whom
chloroquine would be an appropriate antimalarial, can
remain on hydroxychloroquine sulfate.
Chloroquine isno longer recommendedfor thetreatment
of falciparum malariaowing to widespread resistance, nor is
it recommended if the infective species isnot knownor if the
infection ismixed; in these cases treatment should be with
quinine p. 397 ,Malarone®,orRiamet®. It is still
recommended for thetreatment of non-falciparum malaria.Mefloquine
Mefloquine p. 396 is used for theprophylaxis of malariain
areas of the world where there is ahigh risk of chloroquine
resistant falciparum malaria(for details, see Recommended
regimens for prophylaxis against malaria p. 387 ).
Mefloquine is now rarely used for thetreatment of
falciparum malariabecause of increased resistance. It is
rarely used for thetreatment of non-falciparum malaria
because better tolerated alternatives are available.
Mefloquine should not be used for treatment if it has been
used for prophylaxis.Piperaquine with artenimol
Artenimol with piperaquine phosphate p. 393 is not
recommended for thefirst-line treatment of acute
uncomplicated falciparum malaria because there is limited
experience of its use in travellers who usually reside in areas
where malaria is not endemic. Piperaquine has a long half-
life.Primaquine
Primaquine p. 396 is used to eliminate the liver stages ofP.
vivaxorP. ovalefollowing chloroquine treatment.Proguanil
Proguanil hydrochloride is used (usuallywith chloroquine,
but occasionallyalone) for theprophylaxis of malaria, (for
details, see Recommended regimens for prophylaxis against
malaria p. 387 ).Proguanil hydrochloride used alone is not suitable for the
treatment of malaria; however,Malarone®(a combination of
atovaquone with proguanil hydrochloride p. 394 ) is licensed
for the treatment of acute uncomplicated falciparum
malaria.Malarone®is also used for theprophylaxis of
falciparum malariain areas ofwidespread mefloquine or
chloroquine resistance.Malarone®is also used as an
alternative to mefloquine or doxycycline p. 352 .Malarone®
is particularly suitable for short trips to highly chloroquine-
resistant areas because it needs to be taken only for 7 days
after leaving an endemic area.Pyrimethamine
Pyrimethamine p. 399 should not be used alone, but is used
with sulfadoxine.
Pyrimethamine with sulfadoxine is not recommended for
theprophylaxis of malaria, but can be used in thetreatment of
falciparum malaria with (or following) quinine.Quinine
Quinine is not suitable for theprophylaxis of malaria.
Quinine is used for thetreatment of falciparum malariaor if
the infective species isnot knownor if the infection is mixed
(for details see Malaria, treatment p. 392 ).Tetracyclines
Doxycycline is used in adults and children over 12 years for
theprophylaxis of malariain areas ofwidespread mefloquine
orchloroquine resistance. Doxycycline is also used as an
alternative to mefloquine orMalarone®(for details, see
Recommended regimens for prophylaxis against malaria
p. 387 ).Malaria, prophylaxis 23-Jan-2018
Prophylaxis against malaria
The recommendations on prophylaxis reflect guidelines
agreed by UK malaria specialists, published in the Public
Health England Guidelines for malaria prevention in
travellers from the United Kingdom, 2017. The advice is
aimed at residents of the UK who travel to endemic areas.
For specialist centres offering advice on specific malaria-
related problems see Malaria, treatment p. 392. The choice of
drug for a particular individual should take into account:
.risk of exposure to malaria
.extent of drug resistance
.efficacy of the recommended drugs
.side-effects of the drugs
.patient-related factors (e.g. age, pregnancy, renal or
hepatic impairment, compliance with prophylactic
regimen)
For more information on choice of drug, see also
Antimalarials above. Prophylactic doses are based on
guidelines agreed by UK malaria experts and may differ from
advice in product literature.Weight is a better guide than
age. If in doubt obtain advice from specialist centre (see
under Malaria, treatment p. 392 ).
Protection against bites
Prophylaxis is not absolute, and breakthrough infection
can occur with any of the drugs recommended. Personal
protection against being bitten is very important and is
recommended even in malaria-free areas as a preventive
measure against other insect vector-borne diseases.
Mosquito nets impregnated with permethrin p. 729 provide
the most effective barrier protection against insects (infants
should sleep with a mosquito net stretched over the cot or
baby carrier); mats and vaporised insecticides are also useful.
Diethyltoluamide (DEET) 20 – 50 % (available as sprays, and
modified-release polymer formulations) is safe and effective
when applied to the skin of adults and children over386 Protozoal infection BNFC 2018 – 2019
Infection5