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What is Best drug for chemoprophylaxis in a pregnant woman who is traveling to chloroquine resistant falciparum malaria endemic zone? and explain in detail?
Ans. A. Mefloquine. (Ref. H-17th/pg 1292; Table 203-6)Best drug for chemoprophylaxis in a pregnant woman who is traveling to chloroquine resistant falciparum malaria endemic zone is Mefloquine.Regimens for the Rx of MalariaType of Disease or RxRegimen(s)Uncomplicated Malaria Known chloroquine- sensitive strains of Plasmodium vivax, P. malariae, P. ovale, P. falciparumChloroquine (10 mg of base/kg stat followed by 5 mg/kg at 12, 24, and 36 h or by 10 mg/kg at 24 h and 5 mg/kg at 48 h) or Amodiaquine (10-12 mg of base/kg qd for 3 days)Radical Rx for P. vivax or P. ovale infectionIn addition to chloroquine or amodiaquine as detailed above, primaquine (0.25 mg of base/ kg qd; 0.375-0.5 mg of base/kg qd in Southeast Asia and Oceania) should be given for 14 days to prevent relapse. In mild G6PD deficiency, 0.75 mg of base/kg should be given once weekly for 6 weeks. Primaquine should not be given in severe G6PD deficiency.Sensitive P. falciparum malariaArtesunate (4 mg/kg qd for 3 days) plus sulfadoxine (25 mg/kg)/pyrimethamine (1.25 mg/kg) as a single dose or Artesunatec (4 mg/kg qd for 3 days) plus amodiaquine (10 mg of base/kg qd for 3 days).Multidrug-resistant P. falciparum malariaEither artemether-lumefantrinec (1.5/9 mg/kg bid for 3 days with food) or artesunatec (4 mg/kg qd for 3 days) plus Mefloquine (25 mg of base/kg-either 8 mg/kg qd for 3 days or 15 mg/kg on day 2 and then 10 mg/kg on day 3).Second-line Rx/Rx of imported malariaEither artesunatec (2 mg/kg qd for 7 days) or quinine (10 mg of salt/kg tid for 7 days) plus 1 of the following 3: 1. Tetracycline (4 mg/kg qid for 7 days);2. Doxycycline (3 mg/kg qd for 7 days)3. Clindamycin (10 mg/kg bid for 7 days) or Atovaquone-proguanil (20/8 mg/kg qd for 3 days with food).Severe Falciparum Malaria7Artesunate (2.4 mg/kg stat IV followed by 2.4 mg/kg at 12 and 24 h and then daily if necessary) or Artemetherc (3.2 mg/kg stat IM followed by 1.6 mg/kg qd) or Quinine dihydrochioride (20 mg of salt/kg/7 infused over 4 h, followed by 10 mg of salt/kg infused over 2-8 h q8h/) or Quinidine (10 mg of base/kgh infused over 1-2 h, followed by 1.2 mg of base/kg per hour with electrocardiographic monitoring).