Prescribing Notes

Malaria

The fixed-dose combinations of artemether + lumefantrine and piperaquine + dihydroartemisinin are used for the treatment of uncomplicated Plasmodium falciparum malaria.

Chloroquine is used for treatment and prophylaxis of malaria. In many areas where malaria is endemic the malarial parasite is chloroquine resistant and another class of antimalarial should be used.

Mefloquine has been shown to be effective in the treatment and prophylaxis of chloroquine-resistant and multi-resistant Plasmodium falciparum malaria.

Proguanil is used only in malaria prophylaxis. Proguanil in a fixed dose combination with atovaquone may be used in acute uncomplicated P. falciparum malaria showing resistance to other antimalarials.

Pyrimethamine is given as a weekly dose. However, because of the spread of resistance, the drug is considered suitable for use only in residents of areas where pyrimethamine is known to be effective. It is no longer recommended as a prophylactic for travellers.

Dapsone is a weak antimalarial and should not be used alone. The combination of pyrimethamine and dapsone is useful for malaria prophylaxis even in chloroquine resistant areas. Doses must be given on a weekly not daily basis.

Doxycycline is used for prophylaxis in areas of mefloquine-resistant falciparum malaria, and as an alternative for travellers visiting high risk areas who are unable to take chloroquine or mefloquine. The recommended dose is 100mg daily. It is unsuitable for use in children and during pregnancy. It may cause photosensitivity, so patients should be advised to avoid prolonged exposure to the sun.