Quick malaria question. . .

[Mr Pharm S]

Had a lady in today had to urgently go back home to Africa tonight and asked about malaria prophylaxis.

Recomended prophylaxis was malarone, doxy and meflo. Problem is she couldnt get to see her Doc before her flight.

She asked if she could buy the other ones over the counter anyway (which were not indicated for that region). Her thought was at least Im taking something to stop me getting malaria.

I refered her to our local travel clinic this afternoon to try and get the indicated meds.

Anyway she left with no prophylaxis.

Q1. Would Paludrine and chloroquine offer any protection against malaria even though its not indicated for that region?
Q2. How professional/ethical would it have been if I'd sold the OTC meds that are not indicated for that region?

Also she asked a question that I couldnt answer which was

Would she be more immune against malaria since she'd had it previously?

I guess it would depend on the type of malaria she'd been exposed to previously and what type is present in the area she's going to. But do you build up an immune response to malaria like you would with any other infection? I cant see why you wouldnt but can anyone shed some light?

[johnep]

In this situation which I have experienced several times,(usually on way to airport). Advise contact medical centre at airport.
johnep

[Sir_Dispensalot]

Had a lady in today had to urgently go back home to Africa tonight and asked about malaria prophylaxis.

Recomended prophylaxis was malarone, doxy and meflo. Problem is she couldnt get to see her Doc before her flight.

She asked if she could buy the other ones over the counter anyway (which were not indicated for that region). Her thought was at least Im taking something to stop me getting malaria.

I refered her to our local travel clinic this afternoon to try and get the indicated meds.

Anyway she left with no prophylaxis.

Q1. Would Paludrine and chloroquine offer any protection against malaria even though its not indicated for that region?
Q2. How professional/ethical would it have been if I'd sold the OTC meds that are not indicated for that region?

Also she asked a question that I couldnt answer which was

Would she be more immune against malaria since she'd had it previously?

I guess it would depend on the type of malaria she'd been exposed to previously and what type is present in the area she's going to. But do you build up an immune response to malaria like you would with any other infection? I cant see why you wouldnt but can anyone shed some light?

avloclor/paludrine (AP) doesn't provide effective cover against resistant strains of malaria - if it isn't recommended it's because it won't work - same with antibiotics on resistant strains of bacteria.
it's not unethical/unprofessional providing you warn the patient that there will not be proper antimalarial cover with the AP pack but in that case i wouldn't sell anyway - no point selling someone something that won't work.


Tolerance to malaria does build up over time ( ie symptoms and frequency of attacks decrease with prolonged exposure - unfortunately not a full immune response) however this is lost once you leave the malarious area in question and it is strain-specific.

[lamzee]

If she is going "home", to live permanently in Africa, she isn't going to be taking prophylaxis for the rest of her life anyway. I remember being in Uganda and met some students who had returned to Kampala to live, and had decided not to take the pills, to "get it over with" in the weeks after they landed.

[Shwampa]

Great informative site (from the UK ;-) ) : Malaria Information Page - The Travel Doctor

For more complete info: http://whqlibdoc.who.int/publication...0364_chap7.pdf

Remember them as you might get the smart doctor prescribing for only a week after leaving the risky area. ( Happened to me...the skin specialist answer was when I called him to review the Rx and offer 4 weeks post travel protection was: "4 weeks!..that's ludicrous..change it to 2 weeks". I felt I had an ethical obligation to my patient and hinted to her to see her GP after her return and discuss her regimen with him.

I sent the WHO document to the doctor hoping he'll admit to HIMSELF he was wrong.

[Jen the 3rd]

There's a doctor that was away for the lectures on the life cycle of the Plasmodium. Its a shame we pharmacists had to sit through it to make up for it.

[Pharmanaut]

Great informative site (from the UK ;-) ) : Malaria Information Page - The Travel Doctor

For more complete info: http://whqlibdoc.who.int/publication...0364_chap7.pdf


I sent the WHO document to the doctor hoping he'll admit to HIMSELF he was wrong.

He will say something to himself like this... "How dare the plasmodium get it wrong".

[Jen the 3rd]

He will say something to himself like this... "How dare the plasmodium get it wrong".

Probably only just finished telling off viruses forbeing "immune" to amoxycillin.

[JonF]

Your a very naughty virus!! (in style of Monty Python's Life of Brian)