Malaria Chemoprophylaxis. Prevent Disease, Disability and Premature Death Identify basic facts,...
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Transcript of Malaria Chemoprophylaxis. Prevent Disease, Disability and Premature Death Identify basic facts,...
Malaria Chemoprophylaxis
Prevent Disease, Disability and Premature Death
Identify basic facts, types, and the importance of malaria chemoprophylaxis.
Objectiveهدف
Prevent Disease, Disability and Premature Death
Chemoprophylaxis Types
Side Effects
Overviewمرور
Prevent Disease, Disability and Premature Death
Malaria Defined – Transmission
Mainly by certain species of female mosquitoes of the genus Anopheles
Transfusion
Needles
Congenitally
Prevent Disease, Disability and Premature Death
Malaria Defined Symptoms
Symptoms - fever and flu-like illness (chills, headache, muscle aches, and fatigue)
Symptoms may occur 7 to 9 days after being bitten by an infected mosquito
Malaria may cause anemia and jaundice
Prevent Disease, Disability and Premature Death
Protozoa of the genus Plasmodium
P. falciparum - the most deadly
P. vivax - Middle East, Asia, Oceania, and Central and South America
P. malariae - less common
P. ovale - less common
Plasmodium falciparum infections, if not promptly treated, may cause kidney failure, coma, and death
Malaria Defined Infectious Agent
Prevent Disease, Disability and Premature Death
Malaria Life Cycle
Prevent Disease, Disability and Premature Death
Prevent Disease, Disability and Premature Death
Malaria Chemoprophylaxis
Providers have the ultimate responsibility of prescribing medications for malaria
Choice of regimen is determined by two factors:
Drug resistance in specific locations.
Any allergic or other reaction to the anti-malarial drug of choice
Restriction by job
Prevent Disease, Disability and Premature Death
Malaria Chemoprophylaxis
Mefloquine(Lariam®)
250mg salt(228 mg/base)
Once/week
Chloroquine Phosphate(Aralen®)
500 mg salt(300 mg base)
Once/week
Doxycycline 100 mgOnce/day
Primaquine(terminal prophylaxis for P. Vivax
or P. ovale)
15 mg baseOnce/day for 14 days
Prevent Disease, Disability and Premature Death
Side Effects - Mefloquine
Frequently observed side effects
Vomiting, (3% incidence).Minor neurologic events.
Dizziness, vertigo, headache, decrease in sleep, visual, and auditory disturbances.
Neurologic side effects have an incidence of less than 1%.
Serious adverse events
SeizuresDisorientation, Toxic encephalopathy
Mefloquine is not authorized for prophylaxis in aviators and divers
Prevent Disease, Disability and Premature Death
Side Effects - Chloroquine
Frequently reported symptoms
Anorexia
Diarrhea
Abdominal cramps
Vomiting
Nausea
Mild symptoms reported
Headache
Deafness
Tinnitus
Blurred vision,
– Long-term or high-dosage therapy may result in irreversible retinal damage.
Prevent Disease, Disability and Premature Death
Side Effects - Doxycycline
Common side effects
Nausea
epigastric distress
Vaginitis
Sensitivity to sun exposure
Less frequent Diarrhea
Vomiting
Stomach and esophageal ulceration
– The frequency and severity of gastrointestinal side effects may be reduced by taking doxycycline with meals
– Absorption of this drug is impaired by antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate (Pepto)
Prevent Disease, Disability and Premature Death
Side Effects - Primaquine
The most frequently observed side effects
Abdominal discomfort
Nausea
Headache
Interference with visual accommodation
Do not use during pregnancy
Do not use with G-6-PD deficient individuals (physician determination)
Prevent Disease, Disability and Premature Death
Side Effects – Primaquine (G6PD)
Primaquine is the only currently available drug able to destroy dormant malarial pathogens in liver cells and prevent relapse of P.vivax or P.ovale malaria
Unfortunately, it is a strong oxidizing agent, and can cause severe hemolytic anemia in G-6-PD deficient personnel
Prevent Disease, Disability and Premature Death
What is G6PD deficiency?
G-6-PD deficiency a hereditary, sex-linked enzyme defect that results in the breakdown of red blood cells when the person is exposed to the stress of infection or certain drugs
SymptomsFatiguePale color Shortness of breath Rapid heart rate Yellow skin color (jaundice) Dark urine Enlarged spleen
Prevent Disease, Disability and Premature Death
G6PD deficiency
Members who test G6PD deficient must
Be informed of the deficiency, the signs and symptoms they may experience and why they may occur, and the risks of taking oxidant medications.
Be advised to consult with their unit medic if malaria medications are administered to them
Refer these individuals to the flight surgeon for evaluation
Prevent Disease, Disability and Premature Death
Questions to ask the Patient
What exact city are you going to?
Certain risk is eliminated at higher elevations
What are the dates you’ll be in the country?
Risk may only be during certain seasons
What date are you leaving
If it’s less than a week , may need to consider starting with doxycycline then switching
Prevent Disease, Disability and Premature Death
Questions to ask the Patient (cont’d)
Are you allergic to any medication?
Patient may not be able to take this medication
Have you taken this medication before?
Are you taking any meds now?
Prevent Disease, Disability and Premature Death
Summary
Chemoprophylaxis Types
Side Effects
Prevent Disease, Disability and Premature Death
Questions?
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