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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the absence of a suitable malaria case definition, reliable surveillance data on the impact of malaria are not available. Determinants of case loads, including population movements, environmental changes, lack of political commitment and resources, and resistance to antimalarials and residual insecticides, work towards global deterioration. Some 90% of the Plasmodium falciparum burden is carried by Africa south of the Sahara. There, in 1992, the number of children under five years of age and exposed to high risk was about 106 million. Assuming a malaria attack rate of 0.5-1.5 per child per year, and a case fatality rate of 2%, annual clinical cases and malaria deaths in this population alone come to 53-160 million and 1-3 million, respectively. Roche, a pharmaceutical company with major research efforts in tropical medicine, in collaboration with research centers and international institutions, has recently set up a tropical medicine unit that coordinates and concentrates corporate efforts in this field. The unit aims to make affordable and innovative products available which are effective against major tropical diseases. A commercial product of the unit is Lariam, a major antimalarial used alone or in simultaneous or sequential combinations. The single dose combination of Lariam plus Fansidar (Fansimef) is particularly useful for stand-by or emergency oral therapy. Artemisinine, or its derivatives, followed by one to two doses of Lariam are effective against severe and multiresistant P. falciparum malaria. A new Roche peroxide antimalarial is currently in phase II clinical trials. The unit is also involved in research and development of malaria sporozoite and asexual blood stage vaccine candidates.
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PMID:Commitment of Roche in malaria and other tropical diseases. 825 5

One hundred and five healthy nonimmunes in Colombia took part in a randomize, double-blind comparison of 250 mg of Lariam (L) (active ingredient: mefloquine) on alternate weeks or one tablet of Fansidar (F) (active ingredients: sulfadoxine and pyrimethamine) weekly for malaria prophylaxis during at least six months. Volunteers also gave blood for determination of drug concentrations after six months and/or 24-27 months of prophylaxis. Twenty-five volunteers withdrew involuntarily when they lost their jobs in the company. Two who took L withdrew due to moderate diarrhea and mild nausea or headache, weakness, drowsiness and anxiety. One volunteer stopped taking F due to severe unilateral hypostatic eczema and slight S-T depressions on the ECG. The rest completed at least six (range 6-36) months of prophylaxis. The mean half-life for L was 26 days. The AUCs in the time interval 0-14 days for L varied between 19.3-31.5 mumol x days/l. For the main metabolite, the corresponding range was 28.8-81.3 mumol x days/l. The range of trough concentrations at day 0 and 14 were 0.95-2.01 mumol/l for L and 1.69-5.62 mumol/l for the metabolite. No differences in tolerability and efficacy were noted between L and F. Our kinetic results do not indicate that enzymatic induction or inhibition would be important during long-term prophylaxis with mefloquine. This favors a continued use of the drug for very long periods of time (= years).
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PMID:Comparative tolerability and kinetics during long-term intake of Lariam and Fansidar for malaria prophylaxis in nonimmune volunteers. 825 6

Stand-by therapy is the first treatment of a presumptive malaria by the traveller. Goals and possible indications are listed and the mode of application described. Information of the traveller by the physician is time consuming but very important for the correct use of stand-by therapy. The central message is the instruction to visit a doctor within 12 to 25 hours after intake of stand-by therapy, to avoid the risk of missing other diseases with similar symptoms. Fansimef and Lariam, recommended in Switzerland for stand-by therapy of malaria, are shortly reviewed.
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PMID:[Emergency treatment of malaria during travel]. 837 76

The development of acute neuropsychiatric symptoms in a 10-year-old boy subsequent to his return from travel abroad in Africa, where he had taken the antimalarial agent mefloquine (Lariam), is reported. A 4-week course of cognitive-behavioral therapy was used to effectively treat this substance-induced anxiety disorder, which had been caused by treatment with mefloquine. A review of the literature about adverse neuropsychiatric effects of mefloquine and the differential diagnosis of malaria is provided. In an age in which international travel is occurring with increasing frequency, it is important to obtain travel histories, including exposure to prophylactic medication, when patients present with acute-onset psychiatric symptoms.
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PMID:Case study: neuropsychiatric symptoms associated with the antimalarial agent mefloquine. 939 47

The purpose of this study was to evaluate the teratogenic potential of mefloquine (Lariam) in pregnancy, based on the Roche International Spontaneous Reporting System. Lariam is an anti-malarial drug used both in prophylaxis and treatment of malaria. Teratogenic effects were observed in animals but data from humans are lacking. Women of childbearing potential are currently advised to take contraceptive precautions up to three months after the last dose. The study included 1,627 spontaneous reports of women exposed to Lariam before or during pregnancy, which were received by Roche worldwide since introduction on the market. The data were analyzed considering pregnancy and fetal outcome and type of congenital malformations. The birth prevalence of congenital malformations in women exposed to Lariam is estimated to be 4% and is not different from the prevalence observed in the general population. In addition, the congenital malformations observed with Lariam exposure do not show any specific pattern. The data from our study suggest that the teratogenicity, which was observed in animals at high doses, cannot be applied to humans.
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PMID:Post-marketing surveillance of prophylactic mefloquine (Lariam) use in pregnancy. 945 85

In the UK, mefloquine (Lariam-Roche) has been marketed since 1990 for both malaria prophylaxis and for acute treatment of falciparum malaria. In 1991, we concluded that prophylaxis with mefloquine was appropriate for those travelling to areas where strains of Plasmodium falciparum resistant to chloroquine and proguanil are common. Since then, UK recommendations have changed several times. Recently, mefloquine's use as a prophylactic has been questioned because of reports of neuropsychiatric unwanted effects. This article discusses the place of f2p4oquine in malaria prophylaxis in light of these concerns.
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PMID:Mefloquine and malaria prophylaxis. 968 17

Background: The objectives of this study were (1) to compare the efficacy of Lariam (mefloquine) with that of Fansimef (mefloquine, sulfadoxine, and pyrimethamine), Fansidar (sulfadoxine and pyrimethamine), chloroquine, and placebo in suppressing asexual parasitemia in semi-immune persons living in an area endemic for Plasmodium falciparum malaria; and (2) to compare the tolerance of these drugs when taken over a prolonged period of time. Method: A randomized double-blind comparative placebo-controlled study was undertaken in the village of Biasso, 60 km from Abidjan in the southern part of the Ivory Coast, a region where P. falciparum malaria is endemic. Four hundred and ninety nine male volunteers (five parallel groups), who were inhabitants of Biasso, were involved. The main outcome measures concerned the incidence of malaria breakthroughs (acute malaria attacks) and the incidence of parasitemia. Results: Within this strictly defined epidemiologic context, prophylaxis, taken once weekly, proved to be fully protective (parasitic index: 0) in the Lariam, Fansidar, and Fansimef groups throughout the whole study period. Prophylaxis with chloroquine proved incompletely protective (parasitic index: 2.5) The most frequent side effects were pruritus (5.6%), diarrhea (1.2%) and headache (0.06%). No significant differences in the incidence of side effects in each group (chi-square test) was observed. All side effects were transient and judged to be mild by the investigators. Conclusions: Excellent efficacy was observed in the prophylaxis of P. falciparum malaria with Lariam, Fansidar, and Fansimef as compared to the partial protection provided by chloroquine. Safety and tolerance were comparable in all groups during the whole period of observation (5 months).
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PMID:Mefloquine in the Prophylaxis of P. Falciparum Malaria. 981 95

There has been an increased incidence of malaria among Europeans returning from Africa and Asia. The relatively new antimalarial mefloquine (Lariam) has become extremely popular due to its efficacy in treating the wide-spread chloroquine-resistant Plasmodium falciparum. Mefloquine is used both for prophylaxis and treatment of malaria and is relatively well tolerated. However, since introduced in 1985, there have been over 100 reports of severe neurologic and psychiatric adverse effects associated with its use, including acute psychosis, affective disorders, acute confusional states and seizures. We describe a 39-year-old woman who developed acute psychosis after being given mefloquine prophylaxis. Adverse effects occur more often after therapeutic rather than prophylactic use, and those with a history of seizures or psychiatric illness are at increased risk of developing these reactions. Physicians should be aware of these possible side effects and prescribe mefloquine only when indicated.
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PMID:[Neuropsychiatric side effects of malarial prophylaxis with mefloquine (Lariam)]. 1095 70

Malaria chemoprophylaxis concerns prescribing healthy individuals medication for an infection they have an unknown chance of getting. Sensible use of malaria chemoprophylaxis is a balance between the risk of infection and death, and the risk of side effects. The risk of infection can be broken down into the risk of being bitten by a malaria-infected mosquito and the risk of the malaria parasites being resistant to the drug used for prophylaxis. Our knowledge of these parameters is patchy. The risk of infection is not uniform at a given location and the standard of living will greatly influence risk. It is suggested that chemoprophylaxis should not be recommended in areas with less than ten reported cases of P. falciparum malaria per 1000 inhabitants per year. The resistance pattern is known to a certain extent but, for instance, diverging opinion of how much resistance to chloroquine there is in West Africa illustrates the lack of data. There is much debate on rare adverse events, which usually escape Phase III studies prior to registration and are only picked up by passive, postmarketing surveillance. The lessons over the past 20 years with the introduction of amodiaquine, pyrimethamine/dapsone (Maloprim, GlaxoSmithKline) and pyrimethamine/sulfadoxine (Fansidar, Roche), which were all withdrawn for prophylaxis after a few years, show how sensitive drugs for chemoprophylaxis are to side effects. Three levels of chemoprophylaxis are used: chloroquine in areas with sensitive P. falciparum, chloroquine plus proguanil in areas with low level chloroquine resistance, and atovaquone/proguanil (Malarone, GlaxoSmithKline), doxycycline or mefloquine (Lariam, Roche) in areas with extensive resistance against chloroquine and proguanil. Primaquine and the primaquone analog tafenoquine may be future alternatives but otherwise there are few new drugs for chemoprophylaxis on the horizon.
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PMID:Malaria chemoprophylaxis: when should we use it and what are the options? 1548 77

In France, 4,000 imported malaria cases are reported each year (7,000 to 8,000 estimated). Chemoprophylaxis is essential for prevention in travelers. When malaria is susceptible to chloroquine, this drug (Nivaquine) has to be used. It is given daily in France (1.5 mg/kg per day), from departure to four weeks after return. When low levels of chloroquino-resistance are reported, French authorities recommend the use of chloroquine + proguanil (Savarine) if the body weight is >50 kg or Nivaquine) + Paludrine), if <50 kg), or atovaquone + proguanil (Malarone). Nivaquine) (1.5 mg/kg per day) and Paludrine) (3 mg/kg per day) have to be pursued for one month after return, although Malarone) (1 pediatric tablet/10 kg per day, in children >10 kg weight) may be disrupted after one single week. Adverse events are rarer with atovaquone + proguanil, than with chloroquine + proguanil. When chloroquino-resistance is high, Malarone) or mefloquine (Lariam) are used. Weekly drug regimen is recommended with mefloquine (5 mg/kg per weight) for the travel duration and four weeks after return and the drug tolerance is good in pediatric prophylaxis. Doxycycline is used under conditions in children >8 years of age. New drugs as for tafenoquine, an amino-8 quinoleine, might enhance patients compliance if given monthly.
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PMID:[Malaria chemoprophylaxis in traveling children]. 1565 56


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