Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Paludism can occur quite easily in pregnant women in endemic zones, above all those who are primiparous or in their 2nd or 3rd terms. The onset of paludal attacks can be serious for both the mother and the child. That is to say, besides the obviously imperative therapeutic action, a prophylaxis is also a necessity. The use of antipaludial substances at our disposal has been complicated during the last few years as a result of chloroquine-resistance extension. Besides a few nuances of kinetic nature observed in pregnant women, a good knowledge of teratogenous or embryotoxic effects is necessary. But this remains fragmentary. Among the principal antipaludial medications is quinine (Q), reported to be abortifacient but in reality it is not: it is often poorly tolerated by the mother (hypoglycemia), but is not responsible for abnormalities in children, except under large doses. Chloroquine (CQ), considered to be without harmful effects, can be used in women without large restrictions, even if toxic effects have been observed in animals. The pyrimethamine-sulfanilamide (P-S) combination contains two substances which are a potential risk. Nevertheless, experiments have never showed harmful effects in pregnant women, particularly when under cover of a joint prescription of folinic acid. Proguanil is without doubt the only molecule which can be used without restriction. Two new medications, quinoline methanol, Mefloquine (MQ) and Halofantrine (HF) are contra-indicated for lack of experimentation and because of some abnormalities observed at high doses in animals. Artemisinine and amino-8-quinoline are contra-indicated, and cyclines are strongly inadvised. From the practical point of view, the present use of antipaludial medication in pregnancy should take into account the surrounding risk, namely that of paludism and of treatments. Curatively, Q remains a serious treatment in any form. In CQ-sensitive zones CQ is usable unreservedly in simple attacks. In CQ resistance zones the use of Q seems preferable to that of Fansidar proposed by certain people. MQ and HF, although contra-indicated, have already been employed without inconvenience. By way of prevention, it is important first of all to avoid all leisure stays in endemic zones. If travel is unavoidable or for indigenous people, a chemoprophylaxis, judged according to the local risk of impaludation, is desirable: CQ in sensitive zones, PG+CQ in resistant zones, P-S, as proposed by some people, is normally contra-indicated; MQ and HF are contra-indicated. Protection against nocturnal mosquito bites is still strongly applied (Mosquito net, repellents, insecticides).
 ...
PMID:[Antimalarials and pregnancy]. 181 22

Chemoprophylaxis of malaria on the Thai-Cambodian border is difficult due to the high level of drug resistance. Thirteen separate companies of Royal Thai Marine Militia were placed on 250 mg weekly mefloquine chemoprophylaxis from August 1989 to January 1990. A mean number of 722 soldiers received two or more doses of mefloquine per month for the five month study. The medication was well tolerated and compliance averaged 91%. Substantial numbers of prophylaxis breakthroughs were seen which resulted in 3.2 cases of malaria/100 man-months. Sixty-eight falciparum malaria cases were documented in men who had taken at least two mefloquine doses in the previous four weeks. No serious neuropsychiatric reactions occurred. Mefloquine chemoprophylaxis failures exist on the Thai-Cambodian border and are one sign of the spread of mefloquine resistance.
 ...
PMID:Mefloquine chemoprophylaxis of soldiers on the Thai-Cambodian border. 182 Jun 36

The pharmacokinetics of mefloquine at the therapeutic dose of 750 mg single orally were compared between cured and recrudescent patients with acute uncomplicated falciparum malaria. Mefloquine was well-tolerated during the study. The side-effects found were nausea, vomiting and diarrhea. Five patients showed R-I and two showed R-II types of response. All recrudescent patients came from the eastern border of Thailand. The time taken to clear the parasites (PCT) was significantly longer in patients with recrudescence (99.6 +/- 36.9 and 63.0 +/- 8.9 hours); however, there was no difference regarding fever clearance time (FCT: 39.0 +/- 16.1 and 31.0 +/- 21.3 hours). The maximum concentration (Cmax) and the concentration on the first and second days in cured patients were significantly higher than those of treatment failure patients. Other pharmacokinetic parameters appeared to be similar in both groups. The present study indicates the existence of mefloquine-resistant falciparum malaria in the eastern border of Thailand. Inadequate mefloquine concentration may play an important role in this aspect. In addition, this study also suggests that Cmax or the concentrations on the first or second day of treatment may be used as guidelines to predict the outcome of treatment.
 ...
PMID:Pharmacokinetics of mefloquine in treatment failure. 182 Jun 38

The therapeutic, preventive and curative, habits concerning malaria of expatriates living in Brazzaville, Congo, were investigated on two occasions. In March 1989 and April 1990, a questionnaire was handed out to the pupils of the French school to be filled in by their parents. Three quarters of the expatriates are Europeans, and 85 percent of these are French. In this country where the chemoresistance of Plasmodium falciparum has been established since 1985, chemoprophylaxis was regularly performed by expatriates during their first years of residence to diminish later on; in 1989 it was still practised by more than 50 percent of adults who had been living in the tropics for more than 10 years, but in 1990 this proportion had fallen to 35 percent. Chemoprophylaxis is provided by chloroquine in 3 out of 4 persons and by amodiaquine in 1 out of 5. Mefloquine and the chloroquine-proguanil combination are still rarely prescribed as preventive treatments. About 50 percent of the expatriates have had at least on attack of malaria in the previous 2 years, with or without chemoprophylaxis and irrespective of the measures taken to avoid mosquito bites. Mosquito nets, never sprayed with insecticides, are little used, but air-conditioning at night is favoured by 80 percent of the population studied. Curative treatment was distinctly altered between 1989 and 1990, with a rapidly increasing use of mefloquine or halofantrine after confirmation of the diagnosis or as presumptive therapy.
 ...
PMID:[Prevention and treatment of malaria in expatriates living in Black Africa. Influence of chemoresistance. Investigations conducted in Brazzaville (Congo)]. 183 Jan 44

The therapeutic effects and side effects of mefloquine in falciparum malaria were investigated in an open prospective trial involving 20 patients. None of them had a history of neurologic or psychiatric disorders. Mefloquine was given in a total dose of 1500 mg base. The cure rate was 100%, fever and parasitemia subsided within 3 days. Side effects were vomitus and nausea in 25% of the patients. No neurological or psychiatric disorders were observed. Mefloquine was shown to be a safe therapeutic agent in the dosage used. However, regular follow-up examinations should be done in short intervals because of the possibility of late neuropsychiatric side effects; the patients and their relatives should be informed about this fact.
 ...
PMID:[Clinical experiences with mefloquine in tropical malaria--a prospective study]. 191 70

To measure the effectiveness and tolerance of long-term malaria prophylaxis with mefloquine, the incidence of Plasmodium falciparum malaria and of adverse reactions was compared in Peace Corps volunteers in West Africa who took mefloquine every 2 weeks and in volunteers who took chloroquine phosphate weekly. Mefloquine was only 63% more effective than chloroquine; the monthly incidence of P falciparum infections was one case per 100 volunteers who took mefloquine and 2.7 cases per 100 volunteers who took chloroquine. Using daily proguanil (chloroguanide) hydrochloride in addition to chloroquine did not provide additional protection. All mefloquine prophylaxis failures occurred during the second week of the every-2-weeks dosing regimen in volunteers who had used mefloquine for more than 2 months. Blood concentrations of mefloquine were lower during the second week of the alternate-week regimen than during the first week, suggesting that blood levels are too low during the second week to suppress parasitemia. No serious adverse reactions were observed. The results indicate that a dosing regimen of 250 mg of mefloquine weekly should be considered for travelers to areas with chloroquine-resistant P falciparum malaria.
 ...
PMID:Effectiveness and tolerance of long-term malaria prophylaxis with mefloquine. Need for a better dosing regimen. 198 42

Compliance with malaria prophylaxis or reserve drugs was investigated in 477 individuals travelling to regions with endemic malaria. Correct intake of prophylactic medication was confirmed in 225 out of 285 (= 78%). Compliance was independent of type of drug (Mefloquine, Sulfadoxine-Pyrimethamine, Chloroquine). Two tourists missed to start prophylaxis one week before the onset of their travel. 14 travellers stopped prophylactic medication too early after their return, 31 tourists took too high doses of mefloquine. None of the tourists travelling to countries with a therapeutic reserve only became sick, whereas two travelling to Africa contracted malaria.
 ...
PMID:[Malaria study]. 199 82

Mefloquine and halofantrine are quinine-related aminoalcohols recently introduced for the oral treatment (both drugs) and oral chemoprophylaxis (mefloquine) of malaria. Soon after these new drugs were launched the volume of sales testified to the need for alternative treatments in view of the resistance of Plasmodium falciparum to a variety of drugs, including chloroquine, amodiaquine and sulfadoxine-pyrimethamine. Quinine remains effective but it is difficult to handle. Both mefloquine and halofantrine are remarkably effective against the intraerythrocytic pathogenic forms of malaria; they also have a rapid and prolonged action and a low toxicity. Halofantrine is sometimes incompletely absorbed. Neurological side-effects, usually moderate, have been reported with mefloquinone. Partial cross-resistance has been demonstrated within each class of antimalarials: aminoalcohols, amino-4-quinoleins (chloroquine, amodiaquine) and antifolics-antifolinics (sulfamides, pyrimethamine, proguanil), but not between the classes. Further studies are necessary concerning the absorption and tolerability of mefloquine and halofantrine, as well as the regional level of P. falciparum sensitivity to these new drugs.
 ...
PMID:[Mefloquine and halofantrine, new therapeutic drugs of malaria]. 204 18

At the Department of Communicable and Tropical Diseases, Rigshospitalet, Denmark, mefloquine has been used since 1982 for the treatment of patients with suspected or verified chloroquine and sulfadoxine-pyrimethamine resistant P. falciparum malaria. Eighty-one patients treated with mefloquine are reviewed. Forty patients had complicated malaria; 18 were initially treated with IV quinine. Mefloquine dose for adults was 1,500 mg in one dose or divided in two with six hourly intervals. Mild gastrointestinal side effects were common; in 10 patients, the medication had to be repeated because of vomiting. No neurological or neuropsychiatric side effects were recorded in relation to treatment or during the follow up period (30 days). Temperature subsided with a mean of 2.7 days after initiation of treatment and trophozoites cleared with a mean of 3.6 days. One patient had recrudescence. Mefloquine is found safe and effective for the treatment of P. falciparum malaria and is recommended for treatment of worldwide acquired P. falciparum malaria, although patients should be monitored closely to disclose resistance.
 ...
PMID:Treatment of Plasmodium falciparum malaria with mefloquine alone or in combination with i.v. quinine at the Department of Communicable and Tropical Diseases, Rigshospitalet, Copenhagen 1982-1988. 207 60

Recommendations for the prevention of malaria among travelers have been developed by CDC in consultation with representatives from the Offices of Medical Services of the Department of State and the Peace Corps; the Division of Experimental Therapeutics of the Walter Reed Army Institute of Research; the Office of the Surgeon General, U.S. Army; the Office of the Surgeon General, U.S. Air Force; and the Bureau of Medicine and Surgery, U.S. Navy. Resistance of Plasmodium falciparum to chloroquine has spread to most areas with malaria. Alternative drugs to chloroquine are either associated with adverse reactions, are of limited efficacy, or require complex and detailed instructions for use that reduce compliance. These factors have contributed to a threefold increase in the number of reported P. falciparum infections among U.S. travelers to malarious areas since 1980. A new drug, mefloquine (Lariam), is expected to be highly effective against both chloroquine-resistant and Fansidar-resistant P. falciparum infections. Mefloquine is now recommended as the drug of choice for travelers at risk of infection with chloroquine-resistant P. falciparum. Alternative drugs for travelers who cannot take mefloquine include 1) doxycycline alone or 2) chloroquine alone, with Fansidar available for standby treatment while medical care is sought for evaluation of febrile illness when travelers are in a malarious area. Prospective travelers and health-care providers are advised to call the CDC Malaria Hotline at (404) 332-4555 for detailed recommendations for the prevention of malaria.
 ...
PMID:Recommendations for the prevention of malaria among travelers. 215 46


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>