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5.4 Antiprotozoal drugs


5.4.1 Antimalarials

Note:

The geographical areas where malaria is endemic and the areas of drug resistance are constantly changing.  It is therefore of extreme importance that appropriate up-to-date advice is sought from the Microbiologists regarding the most appropriate antimalarial prophylaxis as well as the need for other protective measures.

Since the period of incubation for the parasite in the human body is from 10-28 days, it is necessary to take prophylactic drugs for one week before travelling, during travel and for four weeks after exposure ceases.

ORAL
Artemether with Lumefantrine tablets (Riamet) - First line agent for the treatment of uncomplicated falciparum malaria
Atovaquone & Proguanil tablets (Malarone) - Second line agent for the treatment of uncomplicated falciparum malaria
Chloroquine Phosphate tablets  (Avloclor)                                  
Chloroquine Sulphate tablets, syrup (Nivaquine)                
Hydroxychloroquine Sulphate tablets                
Mefloquine - see notes                                                      
Primaquine tablets (unlicensed product)
Proguanil tablets 
Pyrimethamine + Dapsone ("Maloprim") tablets                           
Quinine Sulphate tablets                                                           

 

PARENTERAL
Artesunate IV  – First line for the treatment of complicated falciparum malaria (unlicensed indication)
Chloroquine IM/IV  (IM not recommended in children)
Quinine dihydrochloride IV infusion - Second line for the treatment of complicated Falciparum malaria if artesunate unavailable (unlicensed indication)                               
(Dilute with normal saline before infusion over four hours and check BM Stix every 30 minutes)

Note:

The prophylactic use of "Maloprim" is currently being discouraged following several reports of severe adverse reactions to these preparations.

Mefloquine is contraindicated in pregnancy. Pregnancy should be avoided for three months following Mefloquine treatment. Chemoprophylaxis should be started 10 days before departure, with a second dose 3 days before departure. It must not be used for chemoprophylaxis in patients with active, or a history of, psychiatric disturbances such as depression, anxiety disorders, schizophrenia, or other psychiatric disorders.   

5.4.7 Drugs for toxoplasmosis

Pyrimethamine tablets - RED drug 

5.4.8 Drugs for pneumocystis pneumonia

Co-trimoxazole tablets, IV infusion
Dapsone tablets
Pyrimethamine tablets
Pentamidine isetionate nebuliser, IV infusion
Atovaquone oral suspension
Go to the intranet page:
Guidelines for Prophylaxis of Pneumocystis Pneumonia (PCP) 

For link to BNF section: 5.4 Antiprotozoal drugs