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5.5 Protozoal infection

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only 
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

 

 

5.5.1 Leishmaniasis

 

5.5.2 Malaria

Prophylaxis against malaria:

  • 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. 

 

 

 

Treatment of falciparum malaria

 

Note: 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.

 

 

Chloroquine sulfate

  • Tablets 250mg (equivalent to 155mg chloroquine base)
  • Syrup 68mg/5mL (equivalent to 50mg/ chloroquine base/5mL)  U 

 

 

Clindamycin

 

Pyrimethamine/Sulfadoxine  U 

  • Tablets  25mg/500mg

 

 

Quinine sulfate

  •  Tablets  300mg      

Note:

 

 

Quinine dihydrochloride   U

  • Injection 300mg/1mL, 600mg/2mL. For infusion only.

  • Injection 300mg/1mL for intramuscular injection. Available from 'special-order' manufacturer.

Notes:

 

 

Artesunate   U

  • Injection 60mg

Notes:

Alternative reserved for 2nd line treatment ONLY in the following cases following the advice of Consultant in Infectious Diseases :

  • contraindications to Quinine
  • very severe disease (parasite count >20%)
  • deterioration on optimal doses of quinine
  • cardiovascular disease that increases the risks from quinine - patients with falciparum malaria from SE Asia where relative quinine resistance is most likely

 

 

Artemether with Lumefantrine

  • Riamet® Tablets 20mg/120mg

 

 

 

Treatment of non-falciparum malarias     

 

Primaquine   U

  • Tablets 7.5mg

 

 

Toxoplasmosis :

Pyrimethamine

  • Tablets 25mg

Note: 

  • Restricted to use by the HIV specialist team for the management of toxoplasmic encephalitis secondary to HIV/AIDS only [unlicensed]—see section 5.4.7

 

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Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only 
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

Return to Chapter: 5. Infections

Last updated by: Dupe Fagbenro on 12-03-2019 11:10