Many people ask a number of questions when planning their next trip: “Is there a great chance of contracting malaria?”, “How to avoid infection?”, “Are there reliable means of prevention?”, “If a mosquito bites, should I immediately run to the hospital?”, “In which countries are better not to travel?”, “Will I die?”, “And what is malaria in general?”.
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, while up to 1 million cases (0.2%) are fatal. 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 are children, pregnant women and people with low immune status(in particular, HIV-infected). Mosquitoes of the infamous genus Anopheles (Anopheles) also live in Russia, but this does not mean anything. For reproduction in their "carcass" of malarial plasmodia, it is necessary special conditions- it should be constantly very warm, it is desirable that there is a reservoir nearby, say a lake or a swamp. Only under such conditions, mosquitoes begin to multiply rapidly and actively exchange plasmodia. No wonder malaria was previously referred to as "swamp fever".
It follows from the above that if you are not going to Africa, you are not a pregnant woman and not a child, if you have at least some money for treatment (or simply have insurance), there is nothing to be afraid of. It must be understood that dying (which is sad in itself), as a rule, only local residents who do not have the means to receive proper medical care. With the ever-increasing resistance of malarial plasmodia to modern (and not very) medicines, still exist effective ways treatment of this transmissible disease. And this must be understood.
What are the symptoms of malaria? They are very typical - fever up to 38-40 degrees, which is undulating in nature with another rise in temperature on the 3rd or 4th day (the so-called three-day and four-day forms) and severe chills, joint pain, vomiting, enlargement of the liver and spleen. Frequent severe headaches. This is something that can be directly observed by any person without being a doctor.
The peculiarity is that the symptoms of malaria can and usually appear some time after infection. Often up to 2-4 weeks from the time of the bite. Therefore, which is logical, you can “get sick” with malaria while already in Russia, without immediately understanding what it is. Usually everyone thinks, “they say I caught a cold, the flu”, etc. Remember, if you have been to Latin America, Africa or South-East Asia, and you have the above symptoms, run to the doctor! After you say that you enjoyed a couple of weeks of exoticism on the shores of indian ocean You will be given simple tests that will confirm or not confirm the diagnosis. No need to pull! Self-treatment especially!
For those who are very worried and do not want to take risks, there are enough effective measures malaria prevention. The easiest way is to use repellents, which must contain diethyltoluamide (DET). Its content can be judged by the composition of "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 a longer and reliable protection- with 20% content of this chemical agent. I recommend the second option. It makes no sense to use 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 repellant at the same time. To do this, first apply sunscreen, then repellent. By the way, which form of release is better to choose - spray, lotion or cream? I recommend, like many, any form, only on condition that you do not spray it from a can, but evenly apply it to the entire skin area with the help of your palms. When spraying an aerosol, you can skip a patch of skin, and the mosquito will bite there.
Now the most interesting. Methods drug prevention. The choice of drugs for this purpose is not so great as it might seem. There are a number of rules that you simply need to follow if you still decide to take prophylactic antimalarials, and at the same time you did not have the opportunity or desire to see a doctor, which in itself is wrong. Do not forget that drugs given group, have a number of contraindications and side effects, of course I will list them briefly, but this does not relieve you of responsibility for own health and the health of those close to you. Remember, the dose for children under 14 years of age, that is, with a body weight of less than 45 kg, is maintained according to special tables for each specific drug. Do not under any circumstances be self-employed! Found time - and to the pediatrician!. Who should not take these drugs? Pregnant and lactating women, persons with severe diseases of the liver, kidneys, heart. Drugs are very poorly combined with alcohol, the toxicity of both ethanol and the drug you are taking increases. People who have experienced so-called "idiosyncratic" reactions in the past (in Russian, reactions like "well, I didn't expect this, this doesn't happen at all") reactions should take antimalarial drugs with extreme caution.
Now about drugs. Names will be listed first. active substance, then, in brackets, trade names(what to ask in pharmacies).
Chloroquine (Delagil). 250 mg of active ingredient (DV) in one tablet, in a pack of 30 pieces. average cost(SS) in Moscow pharmacies - 150-200 rubles. Prevention Scheme (SP): in the first week, 2 tablets (500 mg) 2 times (for example, on Monday and Thursday), then 2 tablets once a week on the same day (for example, on Monday). The start of prevention (NP) is 4 weeks before the holiday, during the holiday and 4 weeks after the holiday.
Hydroxychloroquine (Plaquenil). 200 mg DV, pack of 60 pieces. SS - 1000-1200 rubles. SP: start of prevention 2 weeks before the holiday, during the holiday and 8 weeks after the holiday. If it was not possible to start prophylaxis 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).
Meflochin ("Lariam"). 250 mg AI, pack of 8 tablets. SS - 750-850 rubles. SP: start of prevention 4 weeks before the holiday, during the holiday and 4 weeks after the holiday. Take 1 tablet (250 mg) once a week.
Atovakuon-proguanil ("Malaron"). 250 mg + 100 mg DV, 12 tablets in a pack. SS - 4300-4600. SP: take 1 tablet x once a day 2 days before travel, every day during travel, and for 7 days after travel.
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 AI, pack of 20 tablets. SS - 10-30 rubles (all for "Doxycyclt"). 100 mg AI, pack of 10 tablets. SS - 270-350 rubles (all for Unidox Solutab). SP: 1 tablet per day 2 days before the trip, during the trip, 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 drugs (nausea, maybe even vomiting, headaches, muscle twitching, sleep disturbances, nightmares, diarrhea, weakness, fatigue, dizziness, etc.). Secondly, the lack of a 100% guarantee that prevention will really work if a mosquito does bite. Third, wasted money. Fourth, ruined vacation. Think ahead, is it worth it? Do you want, and are you ready, to take these drugs according to preventive regimens? Missing one or two days or weeks will make your measures meaningless.
In any case, I recommend you consult your doctor. Find out in advance about the epidemiological situation in the country where you are going on a trip. The main thing is not to panic. Do not forget, after all, that there is such a thing as common sense.
Malaria is an infectious disease transmitted by the bite of an infected female Anopheles mosquito. After a bite, malaria symptoms usually develop within 10-15 days. The disease is accompanied by severe paroxysmal fever, chills, anemia, enlargement of the liver and spleen. Sometimes the symptoms can be mild and mimic SARS. However, if you do not start treatment in the first 24 hours after infection, then a fatal outcome is possible.
Malaria is caused by protozoa of the genus Plasmodium. 5 species of Plasmodium are dangerous for humans: P. vivax, P. ovale, P. malariae, P. falciparum and P. knowlesi. Each type of Plasmodium is characteristic of a certain 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-dangerous countries can also become infected. Malaria is very serious illness but it is highly amenable to prevention and treatment.
Plasmodium requires a very hot and humid climate to reproduce. Before visiting tropical and subtropical regions, you should read the Map of Malaria Risk Areas and Effectiveness of Antimalarial Drugs. If you decide to visit a dangerous region, then you must have a malaria test and a supply of an effective drug with you. Plasmodium in some regions is absolutely insensitive to certain medicinal substances Therefore, it is important to competently approach the choice of prophylactic and medicinal medicines.
How to prevent and treat malaria?
Personal malaria prevention comes down to four methods.
- Early use of chemotherapy drugs.
- Protecting your home from mosquitoes.
- Wear clothing that covers the skin as much as possible.
- The use of repellents that repel mosquitoes.
Antimalarial drugs begin to be taken 1-2 weeks before departure to a dangerous region, continue during the entire stay in the malaria focus and 3-4 weeks after returning. To date, 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 be used for prevention.
Quinine is chemical compound obtained from the bark of the cinchona tree. Historically, it is 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, Rezokhin, Khingamin, Arekhin). Today, pharmacologists have already received drugs that have a more pronounced therapeutic effect than quinine and chloroquine.
Fansidar prophylaxis is carried out according to the standard scheme. And for treatment, fansidar is usually taken with quinine for maximum effectiveness. This well prevents relapses, which are observed with quinine monotherapy.
A fairly convenient and effective remedy is mefloquine (Lariam). For prevention, it is taken once a week according to the standard scheme. Treatment with Lariam is carried out within 1 day after the detection of the fact of infection, since the drug retains a therapeutic concentration in the blood for a long time and continues to work powerfully for several more days. A nice bonus of this drug, we get its property not to damage liver cells.
Prevention with metakelfin lasts long enough - 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 (Malaron) for prevention should be taken more often than other drugs - 2 times a week. Treatment is carried out within 4-7 days. However, strains resistant to proguanil have not yet been identified.
To date, the most popular means from malaria is Riamet (Coartem), which contains an artemisin derivative. This is enough new drug, which is only used to treat malaria. Riamet (Coartem) is taken orally within 3 days from the moment of infection. Thanks to excellent therapeutic effect this drug has earned universal recognition.
Interestingly, 2.4 billion people live in areas where malaria is possible from a mosquito bite. This is 40% of all mankind. Every year, up to 500 million catch the disease. Africa has the most cases, followed by India, Brazil, Sri Lanka, and 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 is the number one deaths in a year. Pneumonia and tuberculosis are behind...
Among the sick, about 30,000 people are tourists who find themselves in dangerous malaria areas. Of these, 1% "leaves".
Today, in most countries of the world, malaria is extremely rare. This is mainly due to the development of medicine and the peculiarities of the climate, because this disease is typical for places with elevated temperature air and high level humidity - "tropical climate". However, drugs for the treatment of malaria are popular in many countries. Let's try to figure out what antimalarial drugs exist, which pills have the appropriate properties, and find out what the instructions say about their use.
To date, antimalarial drugs are more commonly used to prevent malaria than to treat it. Such funds are advised to take with them all tourists who travel to countries where there is an increased likelihood of infection. They are actively used by sailors and other categories of people who are faced with increased risk get malaria.
Among other things, antimalarial drugs have found their use in the treatment of a number of autoimmune diseases.
Antimalarial pills
Mefloquine (Lariam) tablets - taken once a week upon arrival in dangerous areas, starting a week before arrival there.
MALARON - drink every day in places of danger of infection and also 2 weeks after leaving dangerous places to close incubation period illness.
Yes, after two cycles of Loriam, the human liver is as if after hepatitis ... But if you do not take the pills, then a fatal outcome is highly likely.
After MEFLOCHIN and LARIAM there are depressive, depressed states, allergic reactions.
More antimalarial drugs, instructions for use
Powder, tablets, Quinine solution
For malaria, quinine sulfate or hydrochloride is taken orally by adults in 2-3 doses at a daily dose of 1.2 g for a week in a row. At severe cases it is possible to take 1.5 grams of quinine hydrochloride in 3 divided doses.
For kids daily dose varies depending on age. Children under one year old - 0.01 g per month of a baby's life (but not more than 0.1 grams). Children from one year to 10 years - 0.1 grams per 1 year of life; 11 - 15 years old - 1 g, from 15 years old - as an adult. Injections for children are done because tissue dies at the injection site.
In the malignant course of malaria, quinine dihydrochloride is injected deep into the subcutaneous adipose tissue(but not in the muscles) on the 1st day at a dose of 2 g (4 ml of 25% or 2 ml of 50% quinine dihydrochloride solution twice with a break between injections of 68 hours).
At serious condition the first injection is slowly administered intravenously. It must be heated to 35 degrees Celsius. "Drive" 0.5 grams of quinine dihydrochloride. But first, they prepare it. 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.
Then, 0.5 grams (1 ml of a 50% solution) of quinine dihydrochloride is injected immediately into the subcutaneous fatty tissue. Quinine residues in the amount of 1 gram are administered subcutaneously only after 68 hours. You just need to be sure that a person tolerates quinine, since in the presence of a hereditary hypersensitivity to him the introduction into the vein sometimes causes death.
V next days make injections of quinine at a dose of 2 grams per day. As soon as the patient regains consciousness and he does not have diarrhea, then quinine is taken orally.
Delagil tablets 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 amoebiasis. 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, after which half a gram once a week. Correction of rheumatoid arthritis involves taking half a gram of medication per day, while this amount must be divided into two doses. The duration of such therapy is six to eight days, after which a quarter gram is taken for a year.
It should be borne in mind that taking Delagil is categorically contraindicated during pregnancy and breastfeeding, hepatic or kidney 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 old.
Delagin's analogues are Rezokhin, Chloroquine, etc.
Plaquenil tablets 200 mg
Plaquenil's active ingredient is hydroxychloroquine sulfate. Such a medication is usually used to correct rheumatoid arthritis, juvenile rheumatoid arthritis, as well as lupus erythematosus, both systemic and discoid type. Of course, Plaquenil can be used to eliminate and prevent malaria, with the exception of the disease provoked 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 advised to take directly during the meal or drink one glass of milk.
In the prevention of malaria, such a composition should be consumed at four hundred milligrams once a week, while the preventive intake should be started two weeks before the planned entry into the problem country. In the event that the medicine was not taken in advance, the dosage is doubled, while the reception is carried out once a week twice a day with an interval of six hours.
Therapy for 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, with time the dosage is reduced to maintenance. Wash down the tablets with milk.
The 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 the age of six, as well as to children if long-term therapy is necessary (due to increased likelihood occurrence of side effects). Another contraindication to such treatment is retinopathy. There are also a number of cases where the consumption of Plaquenil requires special care.
Analogues of this drug are the compositions of Immard, as well as Hydroxychloroquine.
Akrikhin tablets
Another popular treatment for malaria is Akrikhin. In addition, such a 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 the consumption of 0.1 g of quinacrine 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 mentality, renal failure, cholemia, pregnancy and breastfeeding. Its analogues are Atabrin, Atebrin, Pentilen, Paluzan, etc.
There are other antimalarial drugs on the market, the choice the right 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 Plasmodium, which have two developmental cycles. The asexual cycle (schizogony) takes place in the human body, the sexual cycle (sporogony) - in the body of the mosquito. Antimalarial drugs, as a rule, selectively affect certain stages of development of plasmodium, which makes it possible 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 agents - inhibit the development of tissue forms and are used for:
a) individual (personal) chemoprophylaxis means are used, since they act on pre-erythrocyte forms, for example, chloridine and proguanil(bigumal);
b) prevention of relapse - primaquin(primaquine), quinocide - they stop the growth of paraerythrocyte forms.
3. Gamototropic agents affecting gametes (sexual forms of plasmodium) - primaquine, quinocide, bigumal and chloridine, prescribed for "public" chemoprophylaxis of malaria.
Since in the patient's body plasmodium is located on various stages development, a combination of drugs from these three groups is used.
Most widely used hingamin, superior in effect on the erythrocyte forms of plasmodium, all antimalarial drugs. From gastrointestinal tract Chingamine is absorbed quickly and completely, binds to plasma proteins, and is excreted mainly by the kidneys. Chingamine is taken for all forms of malaria. In addition, it has an amoebocidal effect (prescribed for extraintestinal amebiasis), exhibits immunosuppressive and anti-inflammatory properties (useful for rheumatism and collagenoses). Hingamine is non-toxic and rarely gives side effects, only with prolonged use in high doses, dermatitis, graying of hair, dyspeptic symptoms, hemolytic reaction, visual impairment, damage to the liver and hematopoiesis system can develop.
V last years in combination with antimalarial drugs, sulfanilamide and sulfone derivatives are used (they make it possible to reduce the doses of administered drugs).
Which antimalarial drug to choose depends on where you are going and for how long. Best to choose the latest tools, since the pathogen can be resistant to most drugs. None of the currently available drugs full protection from malaria. Therefore, the only reliable guarantee of health is to avoid mosquito bites. All measures to prevent malaria are to reduce the risk of infection.
Side effects can be very unpleasant, and the effect of the medicine does not occur immediately. Start prophylaxis before you arrive in the epidemic area (approximately 1 week in advance for drugs such as chloroquine, doxycycline and proguanil, but mefloquine should be started 2 weeks before travel, and only malarone 2 days before departure) . Because life cycle malarial Plasmodium is very complex, and the disease has a long incubation period, then taking all antimalarial drugs must be continued for several more weeks after you leave the dangerous area (the exception is malarone, it is taken only 1 week). In the UK, chloroquine and proguanil are approved for long-term malaria prophylaxis, whereas doxycycline is allowed for two years, mefloquine for 1 year, and malarone for only 28 days.
A combination of drugs containing pyrimethamine is commonly used as a prophylaxis for malaria (maloprim) and in the treatment of fulminant three-day 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, because every year the bacteria are more and more resistant to its action. The drug can also be used in combination with proguanil. Combination with proguanil in Africa, where the risk of disease is highest, will give 70% protection. Call your doctor if your health 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 (150mg), which is 300mg, once a week, after meals.
Proguanil is 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 more European countries. The medicine must be used with caution in kidney disease and during pregnancy, but it is best to discuss these issues with your doctor. Side effects: mild disorder stomach, diarrhea, mouth ulcers and (rarely) skin reactions, hair loss.
Dosage: 2 tablets (100mg), 200mg total, once a day.
Mefloquine is definitely recommended, despite the negative attitude of the public towards this drug, as malarial plasmodia are becoming increasingly resistant to the action of chloroquine. Of all 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, convulsions, tinnitus, disturbance visual perception, disruption circulatory system, muscle pain and weakness, joint pain, rash, itching, hair loss, malaise, fever, fatigue, loss of appetite and liver dysfunction, blood deterioration and heart failure. 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, with serious mental disorders, convulsions, hypersensitivity to quinine.
You should also refuse to take the medicine if you have problems with the kidneys and liver, impaired cardiac conduction (arrhythmias) and
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