BNF for Children 2011-2012

336 5.4.1 Antimalarials BNFC 2011–20125 InfectionsMEFLOQUINECautions cardiac conduction disorders; epilepsy(avoid for prophylaxis); not recommended in infantsunder 3 months (5 kg); interactions: Appendix 1(mefloquine)Skilled tasks Dizziness or a disturbed sense of balance mayaffect performance of skilled tasks; effects may persist for upto 3 weeksContra-indications hypersensitivity to quinine; avoidfor prophylaxis if history of psychiatric disorders(including depression) or convulsionsHepatic impairment avoid for chemoprophylaxis insevere liver diseasePregnancy manufacturer advises adequate contraceptionduring prophylaxis and for 3 months afterstopping (teratogenicity in animal studies), but seealso p. 332Breast-feeding present in milk but risk to infantminimal; see also, p. 332Side-effects nausea, vomiting, dyspepsia, abdominalpain, diarrhoea; headache, dizziness, sleep disturbances;less frequently anorexia, bradycardia, fatigue,abnormal dreams, fever, tinnitus, and neuropsychiatricreactions (including sensory and motor neuropathies,tremor, ataxia, anxiety, depression, panicattacks, agitation, hallucinations, psychosis, convulsions);rarely suicidal ideation; very rarely pneumonitis;also reported, circulatory disorders (includinghypotension and hypertension), chest pain,tachycardia, palpitation, cardiac conduction disorders,oedema, dyspnoea, encephalopathy, leucopenia,leucocytosis, thrombocytopenia, muscle weakness,myalgia, arthralgia, visual disturbances, vestibulardisorders, rash (including Stevens-Johnsonsyndrome), pruritus, and alopeciaLicensed use not licensed for use in children under5 kg body-weight and under 3 monthsIndication and doseProphylaxis of malaria preferably started 2½weeks before entering endemic area and continuedfor 4 weeks after leaving (see notes above). By mouthChild body-weight 5–16 kg 62.5 mg once weeklyChild body-weight 16–25 kg 125 mg onceweeklyChild body-weight 25–45 kg 187.5 mg onceweeklyChild body-weight over 45 kg 250 mg onceweeklyLong-term chemoprophylaxis Mefloquine prophylaxiscan be taken for up to 1 yearCounselling Inform travellers and carers of childrentravelling about adverse reactions of mefloquine and, ifthey occur, to seek medical advice on alternative antimalarialsbefore the next dose is due. Also warn travellersand carers of children travelling 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 aboveNote Mefloquine doses in BNFC may differ from those inproduct literature1. Drugs for malaria prophylaxis not prescribable on theNHS; health authorities may investigate circumstancesunder which antimalarials prescribedAdministration Tablet may be crushed and mixedwith food such as jam or honey just before administration1Lariam c (Roche) ATablets, scored, mefloquine (as hydrochloride)250 mg. Net price 8-tab pack = £14.53. Label: 21, 25,27, counselling, skilled tasks, prophylaxis, see abovePrimaquinePrimaquine is used to eliminate the liver stages of P.vivax or P. ovale following chloroquine treatment (fordetails, see p. 331).PRIMAQUINECautions G6PD deficiency (test blood, see underBenign Malarias (treatment), p. 331); systemic diseasesassociated with granulocytopenia (e.g. juvenileidiopathic arthritis, lupus erythematosus); interactions:Appendix 1 (primaquine)Pregnancy risk of neonatal haemolysis andmethaemoglobinaemia in third trimester; see also,p. 331Breast-feeding no information available; theoreticalrisk of haemolysis in G6PD-deficient infantsSide-effects nausea, vomiting, anorexia, abdominalpain; less commonly methaemoglobinaemia, haemolyticanaemia especially in G6PD deficiency, leucopeniaLicensed use not licensedIndication and doseAdjunct in the treatment of Plasmodium vivaxand P. ovale malaria (eradication of liverstages) for dose see Benign Malarias, p. 331Primaquine (Non-proprietary)Tablets, primaquine (as phosphate) 7.5 mg or 15 mgAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809ProguanilProguanil is used (usually with chloroquine, but occasionallyalone) for the prophylaxis of malaria, (fordetails, see specific recommendations by country,p. 332).Proguanil used alone is not suitable for the treatment ofmalaria; however, Malarone c (a combination ofatovaquone with proguanil) is licensed for the treatmentof acute uncomplicated falciparum malaria.Malarone c is also used for the prophylaxis offalciparum malaria in areas of widespread mefloquineor chloroquine resistance. Malarone c is also used as analternative to mefloquine or doxycycline. Malarone c isparticularly suitable for short trips to highly chloroquineresistantareas because it needs to be taken only for 7days after leaving an endemic area.PROGUANIL HYDROCHLORIDECautions interactions: Appendix 1 (proguanil)Renal impairment (see notes under Prophylaxisagainst malaria). Use half normal dose if estimatedglomerular filtration rate 20–60 mL/minute/1.73 m 2 .Use one-quarter normal dose on alternate days if