BNF for Children 2011-2012

BNFC 2011–2012 5.4.1 Antimalarials 335Administration tablets may be crushed just beforeadministrationRiamet c (Novartis) TATablets, yellow, artemether 20 mg, lumefantrine120 mg, net price 24-tab pack = £22.50. Label: 21,counselling, skilled tasksChloroquineChloroquine is used for the prophylaxis of malaria inareas of the world where the risk of chloroquine-resistantfalciparum malaria is still low. It is also used withproguanil when chloroquine-resistant falciparum malariais present but this regimen may not give optimalprotection (see specific recommendations by country,p. 332).Chloroquine is no longer recommended for the treatmentof falciparum malaria owing to widespread resistance,nor is it recommended if the infective species isnot known or if the infection is mixed; in these casestreatment should be with quinine, Malarone c , orRiamet c (for details, see p. 329). It is still recommendedfor the treatment of benign malarias (for details, seep. 331).CHLOROQUINECautions may exacerbate psoriasis, neurological disorders(avoid for prophylaxis if history of epilepsy, seenotes above), may aggravate myasthenia gravis,severe gastro-intestinal disorders, G6PD deficiency(see section 9.1.5); ophthalmic examination with longtermtherapy; avoid concurrent therapy with hepatotoxicdrugs—other interactions: Appendix 1(chloroquine and hydroxychloroquine)Hepatic impairment use with caution in moderate tosevere impairmentRenal impairment manufacturers advise caution; seealso Prophylaxis Against Malaria, p. 332Pregnancy benefit of prophylaxis and treatment inmalaria outweighs risk; see also Benign Malarias(treatment), p. 331 and Prophylaxis Against Malaria,p. 332Breast-feeding amount in milk probably too small tobe harmful; see also Prophylaxis Against Malaria,p. 332Side-effects gastro-intestinal disturbances, headache;also hypotension, convulsions, visual disturbances,depigmentation or loss of hair, skin reactions (rashes,pruritus); rarely, bone-marrow suppression, hypersensitivityreactions such as urticaria and angioedema;other side-effects (not usually associated withmalaria prophylaxis or treatment), see under Antimalarials,section 10.1.3; very toxic in overdosage—immediate advice from poisons centres essential (seealso p. 29)Indication and doseProphylaxis of malaria. By mouthDose (expressed as chloroquine base) preferablystarted 1 week before entering endemic area andcontinued for 4 weeks after leaving (see notesabove)Child up to 12 weeks, body-weight under 6 kg37.5 mg once weeklyChild 12 weeks–1 year, body-weight 6–10 kg75 mg once weeklyChild 1–4 years, body-weight 10–16 kg112.5 mg once weeklyChild 4–8 years, body-weight 16–25 kg 150 mgonce weekly (or 155 mg once weekly if tabletsused)Child 8–13 years, body-weight 25–45 kg225 mg once weekly (or 232.5 mg once weekly iftablets used)Child over 13 years, body-weight over 45 kg310 mg once weeklyCounselling Warn travellers about importance ofavoiding mosquito bites, importance of taking prophylaxisregularly, and importance of immediate visit todoctor if ill within 1 year and especially within 3 monthsof return. For details, see notes aboveTreatment of benign malaria see p. 331Note Chloroquine doses in BNFC may differ from those inproduct literature1Avloclor c (AstraZeneca) ATablets, scored, chloroquine phosphate 250 mg(: chloroquine base 155 mg). Net price 20-tab pack =£1.22. Label: 5, counselling, prophylaxis, see above1Malarivon c (Wallace Mfg) ASyrup, chloroquine phosphate 80 mg/5 mL (:chloroquine base 50 mg/5 mL), net price 75 mL =£8.75. Label: 5, counselling, prophylaxis, see above1Nivaquine c (Sanofi-Aventis) ASyrup, golden, chloroquine sulphate 68 mg/5 mL(: chloroquine base 50 mg/5 mL), net price 100 mL= £4.60. Label: 5, counselling, prophylaxis, see aboveWith proguanilFor cautions and side-effects of proguanil see Proguanil;for dose see Chloroquine and Proguanil1Paludrine/Avloclor c (AstraZeneca)Tablets, travel pack of 14 tablets of chloroquinephosphate 250 mg (: chloroquine base 155 mg) and98 tablets of proguanil hydrochloride 100 mg, netprice 112-tab pack = £8.79. Label: 5, 21, counselling,prophylaxis, see aboveMefloquineMefloquine is used for the prophylaxis of malaria inareas of the world where there is a high risk of chloroquine-resistantfalciparum malaria (for details, see specificrecommendations by country, p. 332).Mefloquine is now rarely used for the treatment offalciparum malaria because of increased resistance. Itis rarely used for the treatment of benign malariasbecause better tolerated alternatives are available.Mefloquine should not be used for treatment if it hasbeen used for prophylaxis.1. Can be sold to the public provided it is licensed andlabelled for the prophylaxis of malaria. Drugs for malariaprophylaxis not prescribable on the NHS; health authoritiesmay investigate circumstances under which antimalarialsare prescribed5 Infections