Malaria: Treatment, brief survey of side effects

• Mefloquine (Lariam®). Not used in cardiac arrhythmias, epilepsy or psychiatric disorders. Insomnia, dizziness, tremor, agitation, psychotic behaviour, nausea. Not to be used together with beta-blockers, calcium antagonists, digitalis or quinine (cumulative cardiotoxicity).

• Chloroquine (Nivaquine®). Pruritus is common in black-skinned people (chloroquine has affinity for melanin-containing tissues). Regular eye check-up is advised to detect retinopathy during long-term use (years). Contra-indicated in psoriasis or in myasthenia. Cardiotoxic if given in rapid IV administration. Reduced immune response after rabies vaccination (not for other vaccinations)

• Proguanil (Paludrine®). Almost no side effects. Rarely aphthous oral lesions.

• Pyrimethamine/Sulphadoxine (Fansidar®). Severe dermal and mucosal lesions (leading to Stevens-Johnson syndrome). Do not give if allergic to sulphonamides.

• Quinine (Quinimax® and others). Bitter, tinnitus, transitory hearing loss, nausea. [Thrombocytopaenia has been described as a rare complication, but P. falciparum malaria itself very frequently causes a drop in the blood platelet count]. Do not use with digitalis, quinidine effect on the heart, not in long QT-syndrome or Brugada syndrome, conversion of atrial fibrillation to sinus rhythm possible. Overdosage: blindness, deafness, cardiorespiratory problems, death. Quinine is a common cause of drug-associated TTP-HUS (thrombotic thrombocytopenic purpura - haemolytic uraemic syndrome).

• Halofantrine (Halfan®). Almost without side effects, but, rarely, severe cardiac problems (conduction disorders). Potential candidates can be excluded by taking an ECG before starting treatment.

• Doxycycline (Vibramycine®). Photosensitivity possible, candidosis of mucosa, not given to pregnant women and young children.

Category: Medicine Notes