TEALE FENNING

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

thanks farah,

that's where the mcqs are from, i thought i had seen them somewhere, just didn't remember where.

do keep posting, i had a lot of fun reading up about malaria today.

r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

Pregnant women with uncomplicated malaria caused by P. malariae, P. vivax, P. ovale, or chloroquine-sensitive P. falciparum infection

Chloroquine(treatment schedule as with non-pregnant adult patients), 2nd line alternative for treatment :hydroxychloroquine

Pregnant women diagnosed with uncomplicated malaria caused by chloroquine-resistant P. falciparum infection

quinine sulfate and clindamycin
Quinine treatment for 7 days for infections acquired in Southeast Asia and for 3 days for infections acquired in Africa or South America
Clindamycin treatment for 7 days regardless of where the infection was acquired.

Pregnant women diagnosed with uncomplicated malaria caused by chloroquine-resistant P. vivax infection

quinine for seven days is recommended regardless of where the infection was acquired. No adequate, well-controlled studies to support the addition of clindamycin to quinine when treating chloroquine-resistant P. vivax infections.

Ref: CDC

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

Doxycycline and tetracycline are generally not indicated for use in pregnant women. (Rare instances, doxycycline or tetracycline can be used in combination with quinine if other treatment options are not available or are not being tolerated, and the benefit of adding doxycycline or tetracycline is judged to outweigh the risks)

Atovaquone/proguanil

pregnancy category C medication and is generally not indicated for use in pregnant women. However, for pregnant women with uncomplicated malaria by chloroquine-resistant P. falciparum infection, atovaquone-proguanil may be used if other treatment options are not available or are not being tolerated, and if the potential benefit is judged to outweigh the potential risks. There are no data on the efficacy of atovaquone/proguanil in the treatment of chloroquine-resistant P. vivax infections.

Mefloquine

pregnancy category C medication and is generally not indicated for treatment in pregnant women. Mefloquine has not been associated with an increased risk of congenital abnormalities; however, a possible association with increase in stillbirths. CDC

mefloquine only when no other treatment options are available and if the potential benefit is judged to outweigh the potential risks.

Ref: CDC

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

For P. vivax or P. ovale infections, primaquine phosphate for radical treatment of hypnozoites should not be given during pregnancy.

Pregnant patients with P. vivax or P. ovale infections should be maintained on chloroquine prophylaxis for the duration of their pregnancy. The chemoprophylactic dose of chloroquine phosphate is 300mg base (=500 mg salt) orally once per week.

After delivery, pregnant patients with P. vivax or P. ovale infections who do not have G6PD deficiency should be treated with primaquine.

Pregnant women diagnosed with severe malaria should be treated aggressively with parenteral antimalarial therapy.

Ref:CDC

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

Literature on their use in pregnancy has been limited and animal studies have suggested that their use in pregnancy be restricted.

Presently, artemisinin compounds cannot be recommended for treatment of malaria in the first trimester. However, they should not be withheld if treatment is considered to be lifesaving for the mother and other antimalarials are considered to be unsuitable.

Malaria can be particularly hazardous during pregnancy. Artemisinin and its derivatives are therefore the drugs of choice for severe malaria and can be used for treatment of uncomplicated malaria during the second and third trimester of pregnancy in areas of multiple drug resistance. Owing to lack of data, their use in the first trimester is not recommended.

Published data on 607 pregnancies in which artemisinin compounds were given during the second or third trimesters no evidence of treatment-related, adverse pregnancy outcomes. Similar data show normal outcomes in 124 pregnancies exposed to artemisinin compounds in the first trimester. These numbers are too small to provide an adequate profile of the safety of these compounds when used to treat malaria in pregnancy.

In animal studies with artemisinin compounds, there is clear evidence of death of embryos and some evidence for morphological abnormalities in early pregnancy.
There is also some evidence for adverse effects on fetal body weight and survival when the drug is given later in pregnancy.

Safety data are limited, artemisinin compounds should only be used in the second and third trimesters when other treatments are considered unsuitable.

Ref: WHO

Xerxes I · Posted: Sat Apr 19, 2008 6:39 pm Post subject:

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

Xerxes I · Posted: Sat Apr 19, 2008 7:13 pm Post subject:

These are protective mainly because the RBC lifespan is reduced and its too short for the predator to develop fully and cause problem, so plasmodium dies with the RBC. That's how I learnt it in MedSchool.

It is also interesting that these haemoglobinopathies are more common in endemic areas for malaria because of natural selection. people with haemoglobinopathies were more resistant to malaria, so their genes survived more. isn't it amazing?

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

well just goes to show Darwin was right after all with natural selection.
wonder why some 'monkeys' slipped through.

as for HbS and C, well i have always known them to be protective and have also read Xerxes' reasoning. so am sticking with protective for now.

let's see what Nick has to say about this when he gets back.

r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region