Malaria is a prevalent protozoal disease impacting individuals across the world. Malaria is a disease caused by a parasite. The parasite is spread to humans through the bites of infected mosquitoes. Other modes of transmission include mother to unborn fetus, blood transfusions and sharing of needles (Mayo Clinic, 2023).  Worldwide, malaria infections in tropical or sub-tropical areas number 290 million cases, with approximately 400,000 deaths per year.  In Canada, malaria infections are approximately 480 cases per year (Government of Canada, 2026).

Once bitten by an infected mosquito it may take up to two weeks for symptoms to appear. For some people the infection remains dormant for up to a year. Symptoms include a high fever and chills, and may also have headache, and diarrhea. If left untreated, the symptoms can be cyclical and the client will experience a ‘malaria attack’, with feeling well to symptomatic (Mayo Clinic, 2023).

Prevention is the best defense. Obtaining an anti-malarial prescription prior to travelling is important. Some meds begin a week prior to travel and continue for a week after returning home. Other prevention includes using DEET products, wearing light clothing and using a mosquito net for sleeping.  For more information of prevention strategies, go to Health Link BC: Malaria prevention | HealthLink BC

Indications for Use:

Antimalarials are used for the prevention or treatment of malaria. There are a number of anti-malarial medications, with some prescribed for malaria that is resistant to other meds. Medication options include atovaquone/proguanil (Malarone), doxycycline, mefloquine, and chloroquine. All the med options have the risk of adverse effects and must be used as prescribed.  All require a prescription.

Our prototype med will be atovaquone/proquanil (ATQ-PG). It is first line therapy and most often the med prescribed in Canada. It is well-tolerated due to minimal adverse effects so adherence if higher than with other meds.

Mechanism of Action:

Antimalarial agents work by targeting specific intracellular processes that impact cell development (Achieng, et al., 2019).

Nursing Considerations:

Antimalarial agents are safe to use for all age groups. Most medications need to be started prior to travel and continue for one week after arriving home.

ATQ-PG:

• take one tablet orally, 1–2 days before entering a malaria-endemic area. Take one tablet at the same time each day for the duration of the stay in the endemic area, and continue for 7 days after leaving the endemic area.
• Take with food or milk to increase absorption and efficacy and to decrease GI effects (Stiyka & Savitz, 2020).

Dose adjustments are not needed for liver dysfunction. Renal dysfunction (creatinine clearance < 30mL/min) is contraindicated.

Contraindicated if hypersensitivity reactions such a anaphylaxis, angioedema, or Steven-Johnson syndrome to atovaquone or proguanil HCL.

Drug Interactions:

• Rifampin will reduce the effectiveness of ATQ-PG.
• Anti-coagulants: warfarin used with ATQ-PG will lead to increased anticoagulant effects. Monitor INR closely.
• Use of tetracycline concurrently can lead to decreased ATQ-PG effects.

Adverse/ Side Effects:

Common side effects include nausea, vomiting, abdominal pain, headache, stomatitis, and diarrhea. Most are not severe enough to warrant discontinuation of the drug (Stiyka & Savitz, 2020).

Rare adverse effects include seizures, rash, mouth ulcers and hepatitis.

Client Teaching:

• Clients should receive instruction to take medication as prescribed and adhere to the full prescription regimen.
• Clients should minimize additional exposure to mosquitoes using preventative means such as repellents, protective clothing, netting, etc.

Now let’s take a closer look at the medication card on chloroquine (Daily Med, 2019;UpToDate, 2021). Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.   Go to the Chapter 12 Antimicrobials Medication Cards

References