0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16
946 Malaria■Chloroquine: bitter taste, blurred vision, nausea, pruritus in dark-
skinned patients; with rapid IV infusion or large IM bolus, hypoten-
sive shock, cardiac arrest; with chronic use, retinopathy; safe in preg-
nancy
■Doxycycline/Tetracycline: gastrointestinal intolerance, photosensi-
tivity, vulvovaginal candidiasis, deposition in growing bones and
teeth; contraindicated in pregnant and lactating women, children
<8 years
■Halofantrine: not available in the US; diarrhea, PR and QT inter-
val prolongation, cardiac arrhythmias; contraindicated in pregnant
and lactating women, cardiac conduction abnormalities, electrolyte
imbalance, concurrent QT-prolonging drugs; avoid within 28 d of
prior mefloquine; check EKG prior to use
■Mefloquine: nausea, dizziness, insomnia, nightmares, neuropsychi-
atric reactions (with prophylaxis, moderate in 1:250–500, severe in
1:10,000; with treatment, severe in 1:250–1,700), convulsions; con-
traindicated in mefloquine allergy, not recommended for patients
with history of seizure disorders, severe psychiatric disorders, or car-
diac conduction abnormalities; now recommended by CDC for pro-
phylaxis in pregnancy, but avoid (especially during 1st trimester) if
possible
■Primaquine: dizziness, nausea, vomiting, abdominal pain; severe
hemolysis in G6PD-deficient patients; contraindicated in patients
with <10% normal G6PD activity; with 10–20% activity, can treat
with adjusted doses (0.6 mg base/kg, max 45 mg, weekly for 8
weeks); contraindicated in pregnancy (for pregnant women with P.
vivax or P. ovale infections, after initial treatment continue chloro-
quine prophylaxis weekly until delivery, then treat with prima-
quine)
■Quinine/Quinidine: bitter taste, cinchonism (tinnitus, hearing
loss, nausea, vomiting, blurred vision), QT interval prolongation,
hypoglycemia; with IV infusion, hypotension, cardiac arrhyth-
mias, death; use cautiously if given within 2 weeks of mefloquine
(increased risk of cardiac toxicity), and in diabetics; for IV quinidine
therapy, cardiac monitoring is required, drug levels should be fol-
lowed and dose reduction is required after 3 days; can be used to
treat severe disease in pregnancy
■Sulfadoxine-pyrimethamine: severe mucocutaneous reactions with
prophylactic dosing (1 in 11,000 to 25,000); contraindicated in sulfa-
allergic patients, children <1 month, generally considered safe in
pregnancy