antibioticsbooks

chapter 41 Quinolines 263
majority of patients taking the drug, patients
with a history of psychiatric issues, including
depression, should avoid taking mefloquine.
Systemic: The syndrome of “cinchonism” (tinnitus,
headache, nausea, and visual disturbances)
is common in patients receiving therapeutic
doses of quinine. These effects can lead to discontinuation
of therapy because of intolerance,
but they resolve after drug discontinuation.
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Important Facts
• In the United States, quinidine is the only
quinoline available intravenously. It is used in
combination regimens for treatment of severe
malaria. Intensive monitoring, including
continuous monitoring of blood pressure and
electrocardiogram (ECG) and serial monitoring
of blood glucose, is required. The dosing of
quinidine is altered in renal failure, which is
not uncommon in severe malaria.
• Unlike other antimalarial drugs, primaquine is
active against the “hypnozoite” forms of P. vivax
and P. ovale that can lay dormant in the
liver and cause relapsing infections. Thus,
a two-week course of primaquine is added to
the antimalarial regimen when infection with
these species is documented.
What They’re Good For
Chloroquine: Treatment of uncomplicated malaria
acquired in chloroquine-sensitive areas (only a
few regions) and prophylaxis against malaria
in travelers to those regions
Mefloquine: Treatment of uncomplicated malaria
acquired in mefloquine-sensitive areas (most of