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)

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:From the Centers for Disease Control. Recommendations for the prevention of malaria among travelers. 215 78

This study investigated travellers to tropical Africa with regard to prophylactic treatment of malaria. A total of 5703 travellers completed a questionnaire on their flights back to the Federal Republic of Germany; 4116 passengers (73.7%) had visited East Africa, while 808 (14.5%) had been to West Africa. The results indicate that 90.2% took a regular chemoprophylaxis against malaria. Nevertheless, 8.1% of the travellers used no antimalarials and in 9.3% chemoprophylaxis was inadequate due to inappropriate advice; for example, 7.5% still took pyrimethamine-sulfadoxine as prophylactic. Mefloquine was correctly taken by 38.9% of the travellers in East Africa; 12.6% used it in West Africa where it is not necessary. Antimosquito measures have a high priority for travellers to tropical Africa and dissemination of this fact must be improved since only 72.6% followed through on such advice.
 ...
PMID:Malaria prophylaxis in travellers to tropical Africa. 218 40

Two billion of persons live in regions where endemic malaria prevails or has reappeared. An estimated on hundred million infected individuals per year have been reported around the world. In front of this alarming situation, the diversity and even the incoherence of the currently proposed prophylactic regimens confuses the therapists and renders difficult the adoption of an efficacious strategy. The extension and gravity of drug resistance of P. falciparum and the withdrawal of anti-vectorial campaign constitute two reasons for the present recrudescence of malaria. The preventive strategies in 1990 are based on: rehabilitation of anti-vectorial campaign particularly against nocturnal mosquito bites, applicable to all, everywhere and at all times, by the means of individual and collective measures and mostly by impregnated nets; chemoprophylaxis for which two situations should be distinguished: the non immune traveler leaving for a short period (inferior or equal to 3 months) to an endemic area: individuals living permanently or for long periods in tropical regions. Prevention for short stays In low risk transmission zone (North Africa, Mexico, large cities of South East Asia) whatever the duration, suppression of chemoprophylaxis is acceptable. In high risk transmission zone, three strategies exist according to the intensity and frequency of drug resistance: zone 1 (P. vivax or drug sensitive P. falciparum): chloroquine at a dose of 100 mg/day for adults (1.5 mg/kg/day for children) 6 days out of 7, from the day of departure trough the whole stay and for one month after the return, is still efficacious; zone 2 (moderate frequency of drug resistance): protection is again ensured by chloroquine only, as in zone 1, or better than that by the association of chloroquine 300 mg once a week and proguanil 200 mg/day (3 mg/kg/day for children). The side effects of mefloquine and the risk of generation drug resistance argue against its general use in this zone particularly in West Africa. In one year, we have already observed three chemoprophylactic failures with mefloquine in individuals returning from this region; zone 3 (high frequency of drug resistance and multiresistance): mefloquine, if well tolerated is justified in weekly intake. In case of contraindications or intolerance to mefloquine, which are becoming more frequent, no substitution for that chemoprophylactic regimen is presently available. In view of these facts, indications, contraindications and posologies of mefloquine should be reviewed to better profit from the remarkable characteristics of this antimalarial. Mefloquine should only be prescribed (excluding curative treatment) for chemoprophylaxis of short stays in zone 3. Some contraindications of this drug should be maintained (pregnant women) or made relative (treatment with B-blockers and in the absence of pediatric studies, children weighing less than 15 kg).(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:[Current strategies for the prevention of malaria]. 219 Jun 70

Chloroquine is currently the drug of choice for treatment of acute attacks of Plasmodium falciparum malaria in chloroquine-sensitive areas. In areas of low level resistance, this drug may still be used (25 mg/kg of body weight in three days) in semi-immune patients. In case of failure, or in areas of high level resistance, quinine (25 mg/kg/day for 3 to 5 days) or, in spite of increasing resistance, Fansidar should be prescribed. Mefloquine, Fansimef and Halofantrine ought to be strictly prescribed to delay occurrence of resistance. Severe attacks require quinine by continuous intravenous infusion. Spleen enlargement does not usually require specific treatment unless poor tolerance is observed. Blood transfusions present a considerable risk of HIV transmission. Appropriate malaria treatment may avoid blood transfusions thus preventing HIV dissemination in Africa.
 ...
PMID:[Treatment of Plasmodium falciparum malaria in Africa (except cerebral malaria)]. 219 75

Mefloquine, a quinoline-methanol antimalarial, is effective single dose therapy for all species of malaria infecting humans, including multi-drug-resistant Plasmodium falciparum. It is used both in prophylaxis and treatment. Mefloquine is available either as the hydrochloride salt alone, or in a combined preparation with sulfadoxine and pyrimethamine. There is no parenteral formulation. Several assay methodologies have been developed, but high performance liquid chromatography has been the most used in recent pharmacokinetic studies. These have shown in healthy volunteers that mefloquine is absorbed with a half-life of 1 to 4 hours and a time to peak concentration of 7 to 24 hours (median 16.7 hours). Mean peak blood concentrations have ranged between 50 and 110 (median 83) ng/ml/mg/kg. Estimates of total apparent volume of distribution (Vd/f) have ranged from 13.3 to 40.9 (median 19.2) L/kg, systemic clearance (CL/f) from 0.022 to 0.073 L/h/kg (median 0.026 L/h/kg), and terminal elimination half-life from 13.8 to 40.9 days (median 20 days). Systemic clearance appears to be increased in late pregnancy. In uncomplicated falciparum malaria, peak blood concentrations are 2 to 3 times higher than those in healthy subjects ranging from 112 to 209 (median 144) ng/ml/mg/kg because of contraction in the total apparent volume of distribution. Systemic clearance is usually reduced but elimination rates are increased (possibly because of reduced enterohepatic recycling). Mefloquine absorption appears to be reduced in severe falciparum malaria; plasma protein binding exceeds 98% in both healthy subjects and patients. No important drug interactions have been identified as yet, but the potential for serious interactions with quinine has not been adequately investigated. More studies are needed on the disposition of mefloquine in children.
 ...
PMID:Clinical pharmacokinetics of mefloquine. 220 97

Mefloquine pharmacokinetics were compared in a randomized clinical trial in Thailand among patients with malaria and healthy volunteers. A single oral dose of 1500 mg mefloquine hydrochloride was administered to 11 patients and 5 volunteers and 750 mg was given to 16 patients and 5 volunteers. Efficacy was 82% for 1500 mg and 63% for 750 mg. In cured patients taking 750 mg mefloquine, peak plasma drug concentration (Cmax) and area under the plasma concentration-time curve (AUC) were significantly greater than in the patients for whom treatment failed (p less than 0.0005 and p less than 0.01, respectively), and plasma mefloquine levels were significantly higher from 8 hours to 18 days after treatment. Mefloquine AUC was reduced and variable in the presence of diarrhea. Compared with noninfected volunteers, clinically ill patients displayed a delayed time to reach peak concentration (p less than 0.01) and significantly higher mefloquine plasma levels in the first 2 days after administration of either the 750 mg or the 1500 mg dose. Mefloquine AUC was similar in patients with malaria and healthy volunteers. Because plasma levels increased in temporal relationship with clinical illness, mefloquine volume of distribution or clearance (or both) was reduced during the acute phase of illness.
 ...
PMID:Mefloquine kinetics in cured and recrudescent patients with acute falciparum malaria and in healthy volunteers. 222

Mefloquine (Lariam) is extensively prescribed for the prevention of malaria in chloroquine-resistant areas. However, in west Africa, most of the strains of Plasmodium falciparum are still sensitive to chloroquine. In addition, a few of these strains are inherently resistant to mefloquine. Under these conditions, we must expect to see the failure of mefloquine prophylaxis in travellers returning from west Africa. We report here 5 such failures. The in vitro susceptibility of Plasmodium falciparum isolates from 4 of these patients was evaluated and showed that all 4 had normal sensitivity to chloroquine and quinine, 3 were resistant to mefloquine and one had reduced susceptibility to mefloquine. Mefloquine blood levels (measured 3 times) were within the normal protective range. These case reports indicate that mefloquine should be used cautiously for malaria prevention in west Africa. They also point out that, regardless of the prophylactic method used, fever in a traveller returning from endemic malaria regions always dictates the analysis of a thick blood smear to rule out the diagnosis of malaria.
 ...
PMID:[Failure of prevention of malaria by mefloquine in West Africa]. 228 3

The pharmacokinetics of mefloquine (M) were studied in 59 male Thai patients with falciparum malaria. Mefloquine was administered alone (750 mg orally; group 1), or with primaquine (PQ, 45 mg; group 2), or in combination with sulfadoxine (1.5 g) + pyrimethamine (75 mg) (MSP; group 3), or as MSP + PQ (group 4). All patients in groups 1, 2 and 4 initially responded to treatment, but two patients from group 1 had RI recrudescent infections. One patient in group 3 failed to respond to treatment and was considered to have RII resistance, while a further patient from this group had RI recrudescence. The pharmacokinetic parameters for group 1 and group 3 were not significantly different. Co-administration of primaquine alone had no significant effect on the pharmacokinetics of mefloquine, but there was a statistically significant decrease in the terminal elimination half-life of mefloquine for group 4 relative to that for group 3.
 ...
PMID:Pharmacokinetics of mefloquine in combination with sulfadoxine-pyrimethamine and primaquine in male Thai patients with falciparum malaria. 228 99

Malaria is still, in spite of intensive efforts to reduce its transmission, the most serious and widespread protozoal infection in man. More than 100 million people suffer of malaria each year and one million, mostly children, die for it. Widespread resistance of P. falciparum to drugs, especially 4-aminoquinoline, has been progressing to such a speed in many endemic malarious areas that therapy and prophylaxis procedures have been changing and new drugs or associations of them have been introduced. Quinine and chloroquine are still the main therapeutic agents against the blood forms of plasmodia, and quinine is the first choice drug in severe and complicated malaria. Mefloquine is highly effective against multiresistant P. falciparum, but it is not yet available in Italy. Association of sulfadoxine or sulfamethoxypyrazine to pyrimethamine can be used for therapy of resistant P. falciparum malaria, but resistance to it is quickly spreading and side effects can be very dangerous. Chemoprophylaxis must be weighed against the risk of toxic effects. Chloroquine is still the drug of choice; tetracyclines can be added, for short periods, in areas of chloroquine resistant malaria and mefloquine could be used in selected group of people, at high risk of infection. For long time protection against malaria infection it is most important to rely on protective measures against mosquito bites: screens, mosquito nets, pyrethroids insecticides, skin repellents and wearing protective clothes. The role of malaria vaccines can be very important in the prevention, but many practical problems have to be solved in order to achieve a wide use of the various preparations actually under trials.
 ...
PMID:[Therapy and prevention of malaria]. 266 57

The spread of chloroquine resistant strains of P. falciparum requires new approaches to treatment especially in tropical Africa. A single dose of 3 tablets of sulfadoxine-pyrimethamine (Fansidar) is a suitable and relatively inexpensive alternative. But under drug pressure resistance to this compound has developed in some South-East Asian countries and in Brazil, giving rise to multiple resistant strains of P. falciparum. A similar pattern has arisen with quinine to which almost 50% of P. falciparum strains have become resistant in Thailand. However the combination treatment of quinine with tetracycline given for 7 days is still successful in most cases. Unfortunately compliance to this regimen is rather poor in out-patients. Mefloquine (Lariam), recently marketed, and if used as 750 mg dose in semi-immune adult patients weighing less than 60 kg, has made possible a single-dose treatment schedule for falciparum malaria. In controlled studies conducted in South-East Asia the success rate of mefloquine was 97% in 445 patients. Since there is some fear of the appearance of resistance of P. falciparum to mefloquine, a combination of this compound with sulfadoxine and pyrimethamine was developed (MSP or Fansimef). Various controlled studies in South-East Asia have shown a success rate of this compound of 97% in 278 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[The treatment of multiresistant falciparum malaria in Southeast Asia]. 266 11


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