Inexpensive malaria treatment in Haiti for chloroquine-intolerant patients

By Robert Vermaire | 11 Jan, 2017

I am working in rural Haiti and the only drugs we keep at the hospital for malaria treatment are chloroquine and primaquine. We have occassional patients who are very intolerant of this medication (mainly with nausea and vomiting) and wonder what others have found to be an inexpensive alternative in chloroquine-sensitive areas (besides giving people anti-emetics which we do at this point).

Replies

 

Margaret Chirgwin Replied at 4:57 PM, 11 Jan 2017

Co-trimoxazole (sulfamethoxazole-trimethoprim 80mg/400mg - septrin) - systematic review results: used as malaria treatment cleared 56%-97% of the malaria infections, reduced fever and improved anaemia. Is a safe and still efficacious for the treatment of P.falciparum malaria in non-pregnant adults and children irrespective of HIV status and antifolate resistance profiles.

4 tablets BD for 2 days.

Quinine is also cheap but you have to make ears ring which is unpleasant!

Robert Vermaire Replied at 7:06 PM, 11 Jan 2017

thank you for the quick response. I looked at some of the studies and will have to try this when necessary. It was hard to find dosing recommendations so I'll work with what you've given for now. Looks like kind of a double dose for 2 days.

Margaret Chirgwin Replied at 8:35 AM, 12 Jan 2017

Sent from my BlackBerry 10 smartphone on the O2 network.


Robert Vermaire replied to a (http://email.ghdonline.org/c/eJxlT8uKhDAQ_Bpz25CHSfSQw8AyvyHRtBrQRGLPyPz9trB7...) discussion in (http://email.ghdonline.org/c/eJxlkE2OgzAMhU9DdkH5gRAWLCqNeo0qgFsshSSTpGV6-zFS...) Malaria Treatment & Prevention: (http://email.ghdonline.org/c/eJxlT8tuxCAM_JpwRBgCbA4cKq32NyISSGKJlwjbaP--RGpP...)


thank you for the quick response. I looked at some of the studies and will have to try this when necessary. It was hard to find dosing recommendations so I'll work with what you've given for now. Looks like kind of a double dose for 2 days.

-- Visit GHDonline to reply, (http://email.ghdonline.org/c/eJxlj01uxCAMhU8TdkT8BZIFi256jYgGZ2IpAQpk0rl9STW7...) upload a file, recommend, or share this discussion (http://email.ghdonline.org/c/eJxlj01uxCAMhU8TdkT8BZIFi256jYgGZ2IpAQpk0rl9STW7...)


Replies to this email are immediately shared with the community.
You are receiving this email because you are a member of GHDonline. Too many emails? Change or turn off your email notification settings by (http://email.ghdonline.org/c/eJxlTjkOwyAQfI0p0S4YFgqKNPmGZQViI9mAMI6V34dI6TKa...) updating your profile. (http://email.ghdonline.org/c/eJxlT8tqxDAM_Jr4ViPFr_jgw176GyGNtYkhcYztbdi_rw2l...)
GHDonline | Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
Stay connected: Twitter (http://email.ghdonline.org/c/eJw9jsuKhTAQRL_GLEN33i6ymM38hsRrqwGNIeZOuH8_EYaB...) Facebook (http://email.ghdonline.org/c/eJwtjkGOhCAURE8jS8IHFFywmE1fw9jwFTIIBOk23n4wmaRW...) Blog (http://email.ghdonline.org/c/eJwtjsuKxCAQRb8mLsXyGRcuZtO_EWKsiYLRYNsd8vdjYOBC...) Google+ (http://email.ghdonline.org/c/eJwtjjFuxSAQRE9jSrQLhoWCIk2uYf0YYiNhQBjH-rcPjiJN...) LinkedIn (http://email.ghdonline.org/c/eJwtjsGOhSAMRb9GdhIKKrpgMZv5DaNShRkEwuM9499PTSZp...)

Margaret Chirgwin Replied at 8:43 AM, 12 Jan 2017

Indeed I too found it hard to find a dose and length of treatment. I found what I posted in the review paper I think. I do not have a experience of using it. Ages ago I was interested in it when I was training semi-literate health workers and I thought it would be a good antibiotic to use particularly in young children where the main differential for high fever was malaria or a chest infection. It was one of my favourite drugs to have in an essential drugs box. usually available . In the UK it is out of favour!

Maimunat Alex-Adeomi Moderator Replied at 2:06 PM, 16 Jan 2017

Hi Robert,

Sulfadoxine/Pyrimethamine combination (S-P) though recommended to be used as part of ACT combination or for IPtP in Pregnancy is still used widely for the treatment malaria is endemic areas.

The dosage regimen for treatment of acute malaria is below; See also attached link

Adults 2 to 3 tablets taken as a single dose.

Pediatric patients
(>2 months to 18 years) The dosage for treatment of malaria in children is based upon body weight:
Weight (kg) Number of Tablets Taken as a Single Dose
>45 3
31 to 45 2
21 to 30 1 ½
11 to 20 1
5 to 10 ½

Attached resource: