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Adverse effects of antimalarials. An update

G A Luzzi1, T E Peto

  • 1University of Oxford, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, England.

Drug Safety
|April 1, 1993
PubMed
Summary

Choosing malaria prophylaxis requires balancing risks. Chloroquine and proguanil are safe but often ineffective. Newer drugs like mefloquine have risks, necessitating careful consideration for travelers.

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Area of Science:

  • Medical Science
  • Tropical Medicine
  • Pharmacology

Background:

  • Malaria prophylaxis and treatment involve various drugs.
  • Accurate risk-benefit analysis for antimalarials is often lacking.
  • Drug safety and efficacy vary significantly for different antimalarial agents.

Purpose of the Study:

  • To evaluate the risk-benefit profile of antimalarial drugs for malaria prophylaxis and treatment.
  • To provide information for informed decision-making regarding antimalarial drug selection.
  • To highlight the limitations of current prophylactic agents due to resistance and adverse effects.

Main Methods:

  • Review of existing literature on antimalarial drug safety and efficacy.
  • Analysis of adverse reaction profiles for commonly used antimalarials.
  • Comparison of risk-benefit ratios for prophylaxis versus treatment scenarios.

Main Results:

  • Chloroquine and proguanil have good safety but declining efficacy for prophylaxis.
  • Pyrimethamine-dapsone (Maloprim) carries a risk of agranulocytosis.
  • Pyrimethamine-sulfadoxine (Fansidar) and amodiaquine are not recommended for prophylaxis due to severe reactions.
  • Mefloquine can cause neuropsychiatric side effects.
  • Treatment of Plasmodium falciparum malaria accepts higher risks; alternatives to chloroquine include quinine, mefloquine, tetracyclines, and artemisinin derivatives.
  • Narrow therapeutic ratios and toxicity risks exist for chloroquine, quinine, and mefloquine, especially with exceeding recommended doses.

Conclusions:

  • Careful risk-benefit assessment is crucial for selecting malaria prophylactic agents.
  • Drug resistance limits the utility of older antimalarials.
  • Emerging antimalarials require careful monitoring for severe adverse events.
  • Treatment regimens for severe malaria necessitate a different risk-benefit calculus than prophylaxis.

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