Active Ingredients: Doxycycline
About doxycycline Doxycycline is an antibiotic as chest infections, skin infections, rosacea, dental infections and sexually transmitted infections of other rare infections.
They are not recommended for prophylaxis because of their short half-life.
Artemisinin and its derivatives generally produce rapid clearance of parasitemia and rapid resolution of symptoms.
The artemisinin derivatives are effective against P. Indications and efficacy Studies have examined longer durations of therapy seven days, and artemisinin-based combination therapy of artemisinin derivatives with mefloquine, lumefantrine, amodiaquine or tetracycline—doxycycline to prevent recrudescence.
Coartemether is licensed in some European countries and in the United States and is becoming widely distributed in Africa for the treatment of malaria.
A review of several studies suggests that mefloquine plus artesunate is as effective as artemether-lumefantrine and may, in fact, be superior Footnote 11.
Randomized controlled trials comparing parenteral artesunate and quinine for the treatment of severe malaria in both adults and children and in different regions of the world clearly show the benefits of artesunate Footnote 12 Footnote 13 Footnote 14.
Artemisinin-based combination therapy ACT is the recommended first-line treatment for uncomplicated falciparum malaria and for the treatment of malaria when the causative species has not been identified Footnote 2.
Parenteral artesunate is recommended by the World Health Organization WHO as the treatment of first choice for severe or complicated malaria Footnote 2.
Artemisinin and its derivatives are available and increasingly used in southeast Asia and Africa, and parenteral artesunate is now available in Canada and can be obtained from the CMN see Appendix V. Note that IV artesunate should be reserved for those who have severe malaria, where it has been proven superior to quinine.
Parenteral quinine is the preferred agent ONLY for those who do not meet WHO criteria for severe malaria and who are unable to tolerate oral therapy. Quinine is preferred in these cases in order to preserve available stocks of artesunate, which are limited in Canada at this time.
Adverse effects, contraindications and precautions Artemisinin and its derivatives are generally well tolerated.
Neurologic lesions involving the brainstem have been seen in rats, dogs and primates given repeated doses of artemisinin derivatives, in particular the lipid-soluble derivatives Footnote 15 Footnote 16.
Cases of delayed hemolytic anemia either recurrent or persistent following use of parenteral artesunate 8 to 32 days after therapy for severe malaria have been reported worldwide.
Patients with high pre-treatment parasitaemia appear to be at higher risk.
Post-artesunate delayed hemolysis PADH is likely the result of the delayed clearance of once-infected erythrocytes, which continue to circulate after the pharmacologic effect of parenteral artesunate, and is not the result of any toxic effect of parenteral artesunate Footnote 18.
Due to the risk of hemolysis, Health Canada and the Canadian Malaria Network CMN recommend a CBC be performed weekly for at least 4 weeks following treatment with parenteral artesunate to monitor patients for anemia.
To date, there have been two human cases of complete heart block associated with the use of artemisinins, but most volunteer and clinical studies have found no evidence of cardiac adverse effects Footnote 22 Footnote 23.
The safety of artemisinin derivatives in pregnancy has not been established; however, it should be noted that malaria in pregnancy is frequently associated with increased morbidity and adverse outcomes of pregnancy Footnote 2 Footnote 24.
A review of the limited available data suggests that artemisinins are effective and unlikely to cause fetal loss or abnormalities when used in late pregnancy Footnote 25. Note that none of these studies had adequate power to rule out rare serious adverse events, even in the second and third trimesters Footnote 25.
It concluded that data on ACT use for treatment of clinical uncomplicated malaria in the second and third trimester of pregnancy indicate that they are safe in terms of pregnancy outcomes.