Many people ask a number of questions when planning their next trip: “Is there a high chance of contracting malaria?”, “How to avoid infection?”, “Are there reliable means of prevention?”, “If you are bitten by a mosquito, should you immediately rush to the hospital?”, “In Which countries are better not to travel?”, “Will I die?”, “And what is malaria anyway?”
I will say right away that the statistics on this moment time, depressing. The annual incidence (i.e., the number of newly registered cases of infection) is, according to various estimates, up to 500 million per year, with up to 1 million cases being fatal (0.2%). Up to 90% of those infected are residents of Africa, especially the central, southern and western regions of the country. The vast majority of those exposed to infection are children, pregnant women and people with low immune status(in particular, HIV-infected people). Mosquitoes of the notorious genus Anopheles also live in Russia, but this does not mean anything. For the reproduction of malarial plasmodia in their “carcass”, it is necessary special conditions- it should be very warm at all times, preferably there should be a body of water nearby, say a lake or a swamp. Only under such conditions do mosquitoes begin to rapidly multiply and actively exchange plasmodia. It is not for nothing that malaria was previously referred to as “swamp fever.”
From the above it follows that if you are not going to Africa, you are not a pregnant woman or a child, if you have at least a little money for treatment (or simply have insurance), there is nothing to be afraid of. You need to understand that, as a rule, only local residents who die (which is sad in itself) do not have the means to receive proper medical care. With the ever-increasing resistance of malarial plasmodia to modern (and not so modern) medicines, still exist effective ways treatment of this vector-borne disease. And this must be understood.
What are the symptoms of malaria? They are very typical - fever up to 38-40 degrees, wavy in nature with another increase in temperature on the 3rd or 4th day (the so-called three-day and four-day forms) and severe chills, joint pain, vomiting, enlarged liver and spleen. Severe headaches are common. This is something that can be directly observed by any person without being a doctor.
The peculiarity is that symptoms of malaria can and, as a rule, appear some time after infection. Often up to 2-4 weeks from the moment of the bite. Therefore, which is logical, you can “get sick” from malaria while already in Russia, without immediately understanding what it is. Usually everyone thinks, “I have a cold, the flu,” etc. Remember, if you have been to the countries of Latin America, Africa or South-East Asia, and you experience the symptoms described above, run to the doctor! After you say that you enjoyed a couple of weeks of exoticism on the shores Indian Ocean, You will be given simple tests that will confirm or not confirm the diagnosis. No need to pull! Self-medicate especially!
For those who are very worried and do not want to take risks, there are enough effective measures prevention of malaria. The easiest way is to use repellents that must contain diethyltoluamide (DET). Its content can be judged by the composition of the “mosquito and tick repellent”. It is expressed as a percentage - usually it is either 7-10%, or 20% or more. For protection for several hours, a repellent with low content DET, for longer and reliable protection- with 20% content of this chemical agent. I recommend the second option. There is no point in using a repellent with a very high concentration of DET; it is unlikely to increase the degree of protection, but you can easily get skin irritation.
Often use sunscreen and repellent at the same time. To do this, first apply sunscreen, then repellent. Oh, by the way, which form of release is better to choose - spray, lotion or cream? I recommend, like many others, any form, only on the condition that you do not spray it from a spray can, but apply it evenly over the entire area of the skin using your palms. When spraying an aerosol, you can miss an area of skin, and the mosquito will bite there.
Now comes the fun part. Methods drug prophylaxis. The choice of drugs for this purpose is not as wide as it might seem. There are a number of rules that simply must be followed if you nevertheless decide to take prophylactic antimalarial drugs, and at the same time you did not have the opportunity or desire to see a doctor, which in itself is wrong. Don't forget that drugs given group, have a number of contraindications and side effects, I will, of course, list them briefly, but this does not relieve you of responsibility for own health and the health of people close to you. Remember, the dose for children under 14 years of age, i.e., with a body weight of less than 45 kg, is maintained according to special tables for each specific drug. Do not engage in amateur activities under any circumstances! Find time - and see the pediatrician! Who should not take these drugs? Pregnant and lactating women, persons with severe diseases of the liver, kidneys, and heart. The drugs combine very poorly with alcohol; the toxicity of both ethanol and the drug you are taking increases. People who have had so-called “idiosyncratic” reactions in the past should take antimalarial drugs with extreme caution.
Now about the drugs. Names will be listed first active substance, then, in parentheses, trade names(what to ask in pharmacies).
Chloroquine (Delagil). 250 mg of active substance (AI) in one tablet, 30 pieces in a pack. average cost(SS) in Moscow pharmacies - 150-200 rubles. Prevention regimen (SP): in the first week, 2 tablets (500 mg) 2 times (for example, on Monday and Thursday), then 2 tablets once a week, strictly on the same day (for example, on Monday). Start of prophylaxis (NP) - 4 weeks before vacation, during vacation and 4 weeks after vacation.
Hydroxychloroquine (Plaquenil). 200 mg DV, 60 pieces in a pack. SS - 1000-1200 rubles. SP: start of prophylaxis 2 weeks before vacation, during vacation and 8 weeks after vacation. If it was not possible to start prevention in a timely manner, you can take a “loading dose” of 4 tablets (800 mg) once on the eve of departure. Take once a week, strictly on the same day, 1 tablet (200 mg).
Mefloquine (Lariam). 250 mg DV, 8 tablets in a pack. SS - 750-850 rubles. SP: start of prophylaxis 4 weeks before vacation, during vacation and 4 weeks after vacation. Take 1 tablet (250 mg) 1 time per week.
Atovaquone-proguanil ("Malaron"). 250 mg + 100 mg DV, 12 tablets in a pack. SS - 4300-4600. SP: take one tablet once a day 2 days before the trip, every day during the trip and for 7 days after the trip.
Sulfadoxine + Pyrimethamine (Fansidar). 500 mg + 25 mg DV, 3 tablets in a pack. SS - 200-300 rubles. SP: take 2 tablets a week before the trip, also 2 tablets once a week during the trip and the first 6 weeks after the trip.
Doxycycline (“Unidox Solutab”, “Doxycycline”). 100 mg DV, 20 tablets in a pack. SS - 10-30 rubles (all for Doxycycltna). 100 mg DV, 10 tablets in a pack. SS - 270-350 rubles (all for Unidox Solutab). SP: 1 tablet per day 2 days before the trip, while traveling, also take 1 tablet 1 time per day, upon arrival home continue taking 1 tablet daily for 4 weeks.
So what do we have? Firstly, a bunch of side effects from taking the drugs (nausea, maybe even vomiting, headaches, muscle twitching, sleep disturbances, nightmares, diarrhea, weakness, fatigue, dizziness, etc.). Secondly, there is no 100% guarantee that the prevention will actually work if the mosquito does bite. Thirdly, money wasted. Fourthly, a ruined vacation. Think in advance, is it worth it? Do you want, and are you ready, to take these medications according to preventive regimens? Skipping one or two days or weeks will lead to the meaninglessness of the measures you are taking.
In any case, I recommend that you consult a doctor. Find out in advance about the epidemiological situation in the country where you are going to travel. The main thing is not to panic. Don’t forget, after all, that there is such a thing as common sense.
Malaria is an infectious disease that can be contracted by the bite of an infected female Anopheles mosquito. After a bite, symptoms of malaria usually develop within 10-15 days. The disease is accompanied by severe paroxysmal fever, chills, anemia, and enlarged liver and spleen. Sometimes the symptoms can be mild and mimic ARVI. However, if treatment is not started within the first 24 hours after infection, death is possible.
Malaria is caused by protozoa of the genus Plasmodium. Five species of Plasmodium are dangerous to humans: P. vivax, P. ovale, P. malariae, P. falciparum and P. knowlesi. Each type of plasmodium is characteristic of a specific area.
Every year, about half of the world's inhabitants are at risk of contracting malaria. Most constitutes the population living in hazardous areas. However, travelers visiting malaria-prone countries can also become infected. Malaria is very serious illness, but it is highly preventable and treatable.
Plasmodium requires a very hot and humid climate to reproduce. Before visiting tropical and subtropical regions, you should familiarize yourself with the Map of Malaria Risk Zones and the Effectiveness of Antimalarial Drugs. If you decide to visit a dangerous region, you must have a malaria test and a supply of an effective drug with you. Plasmodium in some regions is completely insensitive to certain medicinal substances, therefore, it is important to competently approach the choice of preventive and medicinal drugs.
How to prevent and treat malaria?
Personal prevention of malaria comes down to four methods.
- Early use of chemotherapy drugs.
- Protecting your home from mosquitoes.
- Wearing clothing that covers as much skin as possible.
- Using mosquito repellents.
Antimalarial drugs begin to be taken 1-2 weeks before departure to a dangerous region, continue throughout the entire period of stay in the malaria focus and 3-4 weeks after return. Today, there are many drugs for malaria based on quinine, chloroquine, mefloquine, fansidar, metakelfin, proguanil and artemisin. Some of these drugs are used only for treatment, others can also be used for prevention.
Quinine is chemical compound, obtained from the bark of the cinchona tree. Historically, it was the first substance that was used to fight malaria.
Chloroquine is a synthetic analogue of quinine. In some regions, malarial plasmodia are resistant to drugs based on chloroquine (for example, Delagil, Rezoquin, Khingamine, Arequin). Today, pharmacologists have already obtained drugs that have a more pronounced therapeutic effect than quinine and chloroquine.
Prevention with Fansidar is carried out according to the standard scheme. And for treatment, Fansidar is usually taken together with quinine for greatest effectiveness. This effectively prevents relapses that occur with quinine monotherapy.
Mefloquine (Lariam) is a fairly convenient and effective remedy. For prevention, it is taken once a week according to the standard regimen. Treatment with Lariam is carried out within 1 day after detection of infection, since the drug maintains a therapeutic concentration in the blood for a long time and continues its powerful work for several more days. A pleasant bonus of this drug is its property of not damaging liver cells.
Prevention with metakelfin lasts quite a long time - it must be continued for six months after returning from a region dangerous for malaria. Treatment is carried out with a single dose of the drug.
Proguanil (Malarone) for prevention must be taken more often than other drugs - 2 times a week. Treatment is carried out for 4-7 days. However, strains resistant to proguanil have not yet been identified.
By far the most popular means for malaria is Riamet (Coartem), which contains an artemisin derivative. This is enough new drug, which is used only to treat malaria. Riamet (Coartem) is taken orally for 3 days from the moment of infection. Thanks to the excellent therapeutic effect this drug has earned universal recognition.
Interestingly, 2.4 billion people live in areas where malaria can be contracted from a mosquito bite. This is 40% of all humanity. Every year, up to 500 million contract the disease. The largest number of cases is in Africa, followed by statistics from India, Brazil, Sri Lanka, as well as Vietnam, Colombia and the Solomon Islands.
Every year up to 3 million people die. Which is already 15 times more than from such a disease as AIDS. Among infectious diseases malaria ranks first in number deaths in a year. Pneumonia and tuberculosis lagged behind...
Among the sick, approximately 30,000 people were tourists who found themselves in dangerous malarial areas. Of these, 1% “leave.”
Today, malaria is extremely rare in most countries of the world. This is mainly explained by the development of medicine and climate conditions, because this disease is typical for places with elevated temperature air and high level humidity – “tropical climate”. However, drugs to treat malaria are popular in many countries. Let's try to figure out what antimalarial drugs exist, which tablets have the appropriate properties, and find out what the instructions say about their use.
Today, antimalarial drugs are more often used to prevent malaria than to treat it. All tourists who travel to countries where there is an increased likelihood of infection are advised to take such products with them. They are actively used by sailors and other categories of people who face increased risk get malaria.
Among other things, antimalarial drugs have found their use in the treatment of a number of autoimmune diseases.
Anti-malarial tablets
Mefloquine (Lariam) tablets - taken once a week upon arrival in dangerous areas, starting a week before arrival there.
MALARON - drink every day in places where there is a risk of infection and also 2 weeks after leaving dangerous places to close incubation period diseases.
Yes, after two cycles of Loriam, a person’s liver looks like it’s after hepatitis... But if you don’t take the pills, there is a high probability of death.
After MEFLOCHIN and LARIAM there is a depressive, depressed state, allergic reactions.
More antimalarial drugs, instructions for use
Powder, tablets, solution Quinine
For malaria, adults take quinine sulfate or hydrochloride orally in 2-3 doses at a daily dose of 1.2 g for a week in a row. At severe cases You can take 1.5 grams of quinine hydrochloride in 3 divided doses.
For children daily dose varies depending on age. Children under one year old - 0.01 g per month of the baby's life (but not more than 0.1 grams). Children from one year to 10 years old - 0.1 grams per 1 year of life; 11 - 15 years - 1 g, from 15 years - as for adults. Injections are given to children because the tissue at the injection site dies.
For malignant malaria, quinine dihydrochloride is injected deep into the subcutaneous fatty tissue(but not into the muscles) on the 1st day at a dose of 2 g (4 ml of 25% or 2 ml of 50% solution of quinine dihydrochloride twice with a break between injections of 68 hours).
At in serious condition The first injection is administered slowly intravenously. It should be heated to 35 degrees Celsius. “Drive in” 0.5 grams of quinine dihydrochloride. But first it is prepared. A 50% solution in an amount of 1 ml of the drug is diluted in a 40% glucose solution in an amount of 20 ml or 20 ml of isotonic sodium chloride solution.
Next, 0.5 grams (1 ml of 50% solution) of quinine dihydrochloride are injected immediately into the subcutaneous fatty tissue. The remaining quinine in the amount of 1 gram is administered subcutaneously only after 68 hours. You just need to be sure that a person can tolerate quinine, since if there is a hereditary hypersensitivity injection into a vein sometimes causes death.
IN next days give injections of quinine at a dose of 2 grams per day. As soon as the patient regains consciousness and does not have diarrhea, then quinine is taken orally.
Tablets Delagil 250 mg
This medicine contains: active substance, like chloroquine. It is commonly used for the treatment and prevention of malaria, as well as for the treatment of amoebic liver abscess and extraintestinal amebiasis. Delagil is used for the correction of subacute and chronic form systemic lupus erythematosus, rheumatoid arthritis, systemic scleroderma, porphyria and photodermatosis.
The dosage of delagil is selected individually. The drug is intended for oral consumption, immediately after a meal. So, in order to prevent malaria, it is recommended to take half a gram twice a week, followed by half a gram once a week. Correction of rheumatoid arthritis involves taking half a gram of medication per day, and this amount must be divided into two doses. The duration of such therapy is six to eight days, after which a quarter of a gram is taken for a year.
It is worth considering that taking Delagil is strictly contraindicated during pregnancy and breastfeeding, hepatic or renal failure, severe violations heart rate, inhibition of hematopoiesis in bone marrow. Contraindications also include porphyrinuria, neutropenia, individual hypersensitivity to the components of the drug, as well as childhood up to six years.
Analogs of Delagin are Rezoquin, Chloroquine, etc.
Tablets Plaquenil 200 mg
The active substance in Plaquenil is hydroxychloroquine sulfate. This medication is usually used to correct rheumatoid arthritis, juvenile rheumatoid arthritis, as well as lupus erythematosus, both systemic and discoid. Of course, Plaquenil can be used to eliminate and prevent malaria, with the exception of the disease caused by chloroquine-resistant strains of the pathogen.
The dosage of the drug should be selected individually, as well as the duration of administration. Plaquenil is recommended to be taken directly during a meal or washed down with one glass of milk.
When preventing malaria, this composition should be consumed at a dose of four hundred milligrams once a week, while preventive use should begin two weeks before the planned entry into the problem country. If the medicine has not been taken beforehand, the dosage is doubled, taking it once a week, twice a day, with an interval of six hours.
Treatment of rheumatoid arthritis and other diseases indicated in the indications can be carried out by taking four hundred to two hundred milligrams of Plaquenil per day, over time the dosage is reduced to maintenance. Take the tablets with milk.
Consumption of this medication is not possible if the patient has hypersensitivity to the components of the drug, hereditary lactose intolerance (lactase deficiency, galactosemia, or glucose or galactose malabsorption syndrome). This medicine is not prescribed during pregnancy and breastfeeding, it is not given to children under six years of age, as well as to children who need long-term therapy (due to increased likelihood occurrence of side effects). Another contraindication to this treatment is retinopathy. There are also a number of cases where the consumption of Plaquenil requires special caution.
Analogues of this drug are the compositions Immard, as well as Hydroxychloroquine.
Akrikhin tablets
Another popular drug for the treatment of malaria is Akrikhin. In addition, this composition can be used to eliminate cestodosis, diphyllobothriasis, giardiasis and systemic lupus erythematosus.
As an antimalarial, it should be taken immediately after a meal with water. On the first day, take three tenths of a gram twice a day, from the second to the fourth - three tenths of a gram at a time.
Correction of systemic lupus erythematosus involves consuming 0.1 g of quinine three times a day for ten days, after which they take a break for five to seven days and repeat the course again.
The drug is contraindicated in case of individual intolerance, disorders nervous activity, unstable psyche, renal failure, cholemia, pregnancy and breastfeeding. Its analogues are Atabrin, Atebrin, Pentilen, Paluzan, etc.
There are other antimalarial drugs on the market, a choice suitable medicine carried out only by a doctor.
Ekaterina, www.site
P.S. The text uses some forms characteristic of oral speech.
The causative agents of malaria are plasmodia, which have two development cycles. The asexual cycle (schizogony) takes place in the human body, and the sexual cycle (sporogony) takes place in the mosquito body. Antimalarials, as a rule, selectively affect certain stages of Plasmodium development, which allows us to distinguish the following groups:
1. Hematoschizotropic agents that destroy erythrocyte forms of plasmodium: chloroquine (hingamin), pyrimethamine (chloridine),quinine, mepacrine (Akrikhin), are used to treat malaria.
2. Histoschizotropic drugs - suppress the development of tissue forms and are used for:
a) individual (personal) chemoprophylaxis uses drugs because they act on pre-erythrocyte forms, for example, chloridine And proguanil(Bigumal);
b) preventing relapses - primaquin(primaquine), quinocide - they stop the growth of paraerythrocyte forms.
3. Gamontotropic agents affecting gametes (sexual forms of Plasmodium) - primaquine, quinocide, bigumal And chloridine, are prescribed for “public” chemoprophylaxis of malaria.
Since plasmodium is present in the patient’s body various stages development, a combination of drugs from these three groups is used.
Most widely used hingamin, which is superior in its effect on erythrocyte forms of plasmodium to all antimalarial drugs. From gastrointestinal tract khingamine is absorbed quickly and completely, binds to blood plasma proteins, and is excreted mainly by the kidneys. Take hingamine for all forms of malaria. In addition, it has an amoebicidal effect (prescribed for extraintestinal amebiasis), exhibits immunosuppressive and anti-inflammatory properties (useful for rheumatism and collagenosis). Khingamin is non-toxic and rarely produces side effects, only with long-term use in high doses can dermatitis, graying of hair, dyspeptic symptoms, hemolytic reaction, visual impairment, damage to the liver and hematopoietic system develop.
IN last years in combination with antimalarial drugs, sulfonamide and sulfone derivatives are used (they make it possible to reduce the doses of administered drugs).
Which antimalarial drug you choose depends on where you are going and for how long. It's best to choose the latest tools, since the pathogen can be resistant to most drugs. None of the currently existing drugs gives full protection from malaria. Therefore, the only reliable guarantee of health is to avoid mosquito bites. All measures to prevent malaria involve reducing the risk of infection.
Side effects can be very unpleasant, and the effect of the medicine does not occur immediately. Start your preventive course before you arrive in the epidemic area (about 1 week for drugs such as chloroquine, doxycycline and proguanil, but mefloquine should be started 2 weeks before travel, and malarone only 2 days before departure) . Because life cycle malarial plasmodia is very complex, and the disease has a long incubation period, then taking all antimalarial drugs must be continued for several weeks after you leave the dangerous area (the exception is malarone, it is taken only for 1 week). In the UK, chloroquine and proguanil are approved for long-term malaria prevention, whereas doxycycline is approved for two years, mefloquine for one year, and malarone for only 28 days.
A combination of drugs containing pyrimethamine is commonly used as a prophylaxis against malaria (Maloprim) and in the treatment of fulminant malaria (Fansidar). Currently, these drugs are used in cases where other more effective drugs are contraindicated or cannot be obtained.
Chloroquine - becomes less effective drug, since every year bacteria are more and more resistant to its action. The medicine can also be used in combination with proguanil. Combination with proguanil in Africa, where the risk of disease is highest, will provide 70% protection. Call your doctor if your medical condition prevents you from taking this drug. Side effects: gastrointestinal disorders, headache, convulsions, visual disturbances, depigmentation, hair loss and skin reactions. Side effects are often mild.
Dosage: 2 tablets (150 mg), which is 300 mg, 1 time per week, after meals.
Proguanil - usually taken in combination with chloroquine. The drug is difficult to obtain in the US, although it is available in the UK. Australia, New Zealand and many European countries. The medicine should be used with caution if you have kidney disease and during pregnancy, but it is best to discuss these issues with your doctor. Side effects: mild disorder stomach, diarrhea, ulcers on the oral mucosa and (rarely) skin reactions, hair loss.
Dosage: 2 tablets (100 mg), total 200 mg, once a day.
Mefloquine is definitely recommended, despite the negative public attitude towards this drug, since malarial plasmodia are becoming increasingly resistant to the action of chloroquine. Of all the existing antimalarial drugs, mefloquine gives the best protection, approximately 90%. However, the high price and side effects make it unpopular. Side effects: nausea, vomiting, diarrhea, drowsiness, loss of coordination, headache, sleep disturbance, anxiety, depression, hallucinations, seizures, tinnitus, disturbance visual perception, disruption circulatory system, muscle pain and weakness, joint pain, rash, itching, hair loss, malaise, fever, feeling tired, loss of appetite and liver dysfunction, deterioration of blood composition and heart dysfunction. Serious consequences, which are so often talked about in the media mass media, are greatly exaggerated. The drug should not be taken in the first months of pregnancy, during breastfeeding, or with serious mental disorders, convulsions, hypersensitivity to quinine.
You should also stop taking the medicine if you have problems with the kidneys and liver, cardiac conduction disorders (arrhythmias) and
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