0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16
Malaria 945➣OR Artesuntate* (alone or in combination with longer-acting
agent)
➣OR Artemether* (alone or in combination with longer-acting
agent)
➣OR Halofantrine
Sulfadoxine-pyrimethamine (Fansidar) single agent – avoid due to
widespread resistance
■Severe Chloroquine-Resistant Malaria
➣Quinine parenterally
➣OR Quinidine: call Eli Lilly Company (800-821-0538) if rapid ship-
ment of drug is needed
➣OR Artesunate*
➣OR Artemether*
*Not available in US
■Chemoprophylaxis
➣Avoiding mosquito bites is best protective measure; advise
patients to use insect repellant (20–35% DEET), suitable clothing,
and permethrin-treated bed nets.
➣Prophylactic regimens should be started 1–2 weeks prior to
departure and continued for 4 weeks after return.
➣Chloroquine: only for chloroquine-sensitive regions
➣Mefloquine (Larium): for chloroquine-resistant areas
➣Doxycycline: for mefloquine-resistant areas and as an alternative
to mefloquine
➣Atovaquone/Proguanil (Malarone): adult dosing, one tablet
daily; begin 1–2 days before departure and continue for 7 days
after return
➣Chloroquine PLUS Proguanil: no longer recommended by CDC
➣Self-treatment: consider for patients traveling to chloroquine-
resistant areas who may not have immediate access to medical
care; advise patients to take medication only if fever develops
and to seek medical care at once; sulfadoxine-pyrimethamine
(Fansidar)Side Effects & Contraindications
■Artemisinin derivatives: not available in US; decreased reticulocyte
count, mild EKG changes, neurotoxicity in animals (not reported in
humans); limited data on use in pregnancy
■Atovaquone/Proguanil: abdominal pain, nausea, vomiting,
headache; not recommended for use in pregnant and lactating
women, or children <11 kg due to insufficient data