5.4 Antiprotozoal drugs

5.4.1 Antimalarials

Malaria prophylaxis

  • The Department of Health advises GPs that private prescription forms should be used to prescribe drugs for malaria prophylaxis. Chloroquine and proguanil are available 'over the counter' (OTC) whereas mefloquine and Malarone® require a private prescription.
  • Refer to BNF or MIMS for telephone numbers for up to date advice on recommended products.
  • Costs of treatment can vary between community pharmacies. Advise patients to obtain information on cost of dispensing private prescriptions for malaria prophylaxis from their community pharmacy.
  • Due to the risk of mixed falciparum and non-falciparum malarias treatment should be directed against falciparum malaria unless, due to geographical constraints or the results of diagnostic tests, one can be confident that infection is due purely to non-falciparum plasmodia.

Malaria treatment

Drugs used to treat malaria not listed here:

Riamet®
  • Tablets containing artemether 20mg and lumefantrine 120mg
Malarone®
  • Tablets containing proquanil hydrochloride 100mg and atovaquone 250mg
  • Paediatric tablets containing proguanil hydrochloride 25mg and atovaquone 62.5mg
Chloroquine
  • Tablets 250mg (equivalent to 155mg chloroquine base)
  • Oral solution 80mg/5ml (equivalent to 50mg chloroquine base/5ml)
Primaquine
  • Tablets 7.5mg (unlicensed preparation)
Fansidar®
  • Tablets containing pyrimethamine 25mg and sulfadoxine 500mg
Quinine sulphate
  • Tablets 200mg, 300mg

Notes

  1. MHRA Drug Safety Update (December 2014):
    1. Quinine is not a routine treatment for nocturnal leg cramps, and should only be used when cramps regularly disrupt sleep
    2. Before use of quinine for nocturnal leg cramps, the risks should be carefully considered relative to the potential benefits
    3. After a trial of at least 4 weeks, treatment should be stopped if there is no benefit. If treatment continues, the benefits should be assessed around every 3 months
    4. Patients should be warned not to exceed the recommended dose. Serious side effects including irreversible blindness and death may occur with overdose
    5. Thrombocytopenia is a rare but potentially life-threatening adverse reaction associated with quinine. Patients should be instructed to stop treatment and consult a physician if signs of thrombocytopenia occur, such as unexplained petechiae, bruising, or bleeding
  2. MHRA Drug Safety Update (November 2017):
    1. Be aware of dose-dependent effects on the QT interval and use caution if prescribing quinine in patients:
      • with conditions that predispose to QT prolongation such as pre-existing cardiac disease or electrolyte disturbance
      • taking other medicines that could prolong the QT interval
      • with atrioventricular block
    2. Monitor patients closely if administration of quinine with phenobarbital or carbamazepine is necessary; serum levels of these anticonvulsant medicines could become raised and cause anticonvulsant toxicity
    3. Consult the Summary of Product Characteristics for a full list of interacting medicines and potential adverse reactions
Artesunate
  • 60mg powder and solvent for solution for injection
Quinine dihydrochloride
  • Injection 300mg/mL, 600mg/2ml (for infusion only) (unlicensed)

5.4.2 Amoebicides

Drugs used for amoebic infection not listed below:

Diloxanide furoate
  • Tablets 500mg

Notes

  1. For use within Plymouth Hospitals NHS Trust

5.4.8 Drugs for pneumocystis pneumonia

Pentamidine isetionate
  • Injection 300mg
  • Nebuliser solution 300mg
Atovaquone
  • Oral suspension 750mg/5ml (226ml)

 

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