INDICES> Malaria drugs

["Gunnar.Holmgren@ich.uu.se"]

Malaria drugs (2)
__________________

Dear Ian,
In a situation where chloroquine and Fansidar are out of stock,
cotrimoxazole is an acceptable alternative with a dose of 960mg twice daily
for 5-7 days. However if Fansidar resistance is widespread there is a good
chance that resistance to cotrimoxazole is also widespread. Of course if
amodiaquine was available this is better with a dose of 600mg daily for 2
days and then 300mg on the third day. This is effective even where there is
some chloroquine resistance around. Doxycycline is good but slow acting in
acute malaria in a dose of 200 mg daily for 7-10 days. Its real place is in
dealing with recrudescence after an initial fast acting drug. It cannot be
used in pregnancy or childhood under 12 years. Quinine should be reserved
for severe malaria and is too expensive for routine use but if I had nothing
else I would give one day of quinine 10mg salt/kg PO thrice daily and start
at the same time with doxycycline. Quinine resistance comes very slowly
after widespread use.

Yours sincerely,
Gunnar Holmgren,
Consultant in International Health Care
<Gunnar.Holmgren@ich.uu.se>


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