Malaria: Treatment

Malaria: Treatment

Q. 1

Drug of choice for Resistant Plasmodium falciparum malaria in the pediatric age group:

 A

Chloroquine

 B

Tetracycline

 C

Clindamycin

 D

Doxycycline

Q. 1

Drug of choice for Resistant Plasmodium falciparum malaria in the pediatric age group:

 A

Chloroquine

 B

Tetracycline

 C

Clindamycin

 D

Doxycycline

Ans. C

Explanation:

Chloroquine resistant Plasmodium falciparum can be treated with any of the three drugs tetracycline, doxycycline and clindamycin. Since tetracycline and doxycycline cannot be used in children under 8years of age, clindamycin is the drug of choice.

Ref: Nelson 18 th Edition, Page 1421; Harrison 17 th Edition, Page 1290


Q. 2

Tissue schizontocide which prevents relapse of vivax malaria –

 A

Quinine

 B

Primaquine

 C

Pyrimethamine

 D

Chloroquine

Q. 2

Tissue schizontocide which prevents relapse of vivax malaria –

 A

Quinine

 B

Primaquine

 C

Pyrimethamine

 D

Chloroquine

Ans. B

Explanation:

Ans. is ‘b’ i.e., Primaquine

o Primaquine is the only tissue schizonticide to prevent relapse.


Q. 3

The anti-malarial drugs effective in preerythrocytic phase in liver are

 A

Proguanil

 B

Chloroquine

 C

Pyrimethamine

 D

Quinine

Q. 3

The anti-malarial drugs effective in preerythrocytic phase in liver are

 A

Proguanil

 B

Chloroquine

 C

Pyrimethamine

 D

Quinine

Ans. A

Explanation:

Ans. is ‘a’ i.e., Proguanil

o The pre-erythrocytic phase in Liver is targeted for causal prophylaxis. o Drugs acting on pre-erythrocytic cycle ‑

  1. Proguanil             Primarily for falciparum.
  2. Primaquine —> For all species.

Q. 4

Treatment of choice for severe falciparum malaria is –

 A

Chloroquine

 B

IV artesunate

 C

IV quinine

 D

IV quinidine

Q. 4

Treatment of choice for severe falciparum malaria is –

 A

Chloroquine

 B

IV artesunate

 C

IV quinine

 D

IV quinidine

Ans. B

Explanation:

Ans. is ‘b’ i.e., IV artesunate

Treatment of falciparum malaria

o Artimisinin derivatives are the drug of choice for any type of falciparum malaria

i)           Uncomplicated

ii)          Complicated/severe/cerebral

o Amongst artimisinin derivatives, artesunate is the DOC.

o Other drugs used for severe/complicated/cerebral falciparm malaria : Artemether (2nd choice), Quinine (3rd choice), Quinidine.


Q. 5

Drug of choice for treatment of chloroque resistant falciparum malaria-

 A

Quinine

 B

Chloroquine

 C

Pyrimethamine

 D

None

Q. 5

Drug of choice for treatment of chloroque resistant falciparum malaria-

 A

Quinine

 B

Chloroquine

 C

Pyrimethamine

 D

None

Ans. D

Explanation:

Ans. is None

o Artemisinin base combinations are DOC for chloroquine resistant falciparum malaria.

o If you will have to choose one option, go ahead with option ‘a’ i.e. quinine, as quinine can be used along with doxycycline if artemisinin based preparations are not available.

Remembers very simple funda

o Forget about chloroquine sensitivity or resistance, now a days artimisinin based preparations (artesunate, artemether) are the DOCs for any type of falciparum infection (uncomplicated, complicated, severe, cerebral).


Q. 6

Treatment of choice for chloroquine resistant malaria is –

 A

Mefloquine

 B

Sulfadoxine + Pyrimethamine

 C

Primaquine + Chloroquine

 D

Chloroquine + Pyrimethamine

Q. 6

Treatment of choice for chloroquine resistant malaria is –

 A

Mefloquine

 B

Sulfadoxine + Pyrimethamine

 C

Primaquine + Chloroquine

 D

Chloroquine + Pyrimethamine

Ans. B

Explanation:

Ans. is ‘b’ i.e., Sulphadoxine + Pyrimethamine 

o In chloroquine resistant cases of P. falciparum malaria, the first line of treatment is artesunate combination theraphy consisting of —> Artesunate + Sulphadoxine/Sulphalene + Pyrimethamine.

o In case of resistant to these drugs or to treat severe and complicated malaria, quinine is the drug of choice.


Q. 7

Which of the following antimalarial drug is a slow acting schizonticide:     

September 2002

 A

Artemether

 B

Mefloquine

 C

Pyrimethamine

 D

Quinine

Q. 7

Which of the following antimalarial drug is a slow acting schizonticide:     

September 2002

 A

Artemether

 B

Mefloquine

 C

Pyrimethamine

 D

Quinine

Ans. C

Explanation:

Ans. C i.e. Pyrimethamine


Q. 8

Dose of chloroquine for prophylaxis against vivax malaria:          

September 2012

 A

150 mg (base) weekly

 B

300 mg (base) weekly

 C

600 mg (base) weekly

 D

900 mg (base) weekly

Q. 8

Dose of chloroquine for prophylaxis against vivax malaria:          

September 2012

 A

150 mg (base) weekly

 B

300 mg (base) weekly

 C

600 mg (base) weekly

 D

900 mg (base) weekly

Ans. B

Explanation:

Ans. B i.e. 300 mg (base) weekly

Antimalarial prophylaxis

  • In areas where chloroquine remains effective: Chloroquine 300 to 310 mg once weekly, and Proguanil 200 mg once daily (started one week before travel, and continued for four weeks after returning)

Q. 9

Drug of choice for plasmodium vivax is:

September 2006

 A

Mefloquine

 B

Chloroquine

 C

Artesunate

 D

Quinine

Q. 9

Drug of choice for plasmodium vivax is:

September 2006

 A

Mefloquine

 B

Chloroquine

 C

Artesunate

 D

Quinine

Ans. B

Explanation:

Ans. B: Chloroquine

Chloroquine remains the treatment of choice for clinical cure and suppressive prophylaxis of all types of malaria, except that caused by resistant P.falciparum.

In short time visitors to chloroquine-sensitive endemic areas, suppressive dose should be started 1 week before and continued for 4 weeks after returning.


Q. 10

Drug used for chloroquine-resistant vivax malaria are all of the following except:

September 2009

 A

Quinine

 B

Doxycycline

 C

Primaquine

 D

Fluoroquinolones

Q. 10

Drug used for chloroquine-resistant vivax malaria are all of the following except:

September 2009

 A

Quinine

 B

Doxycycline

 C

Primaquine

 D

Fluoroquinolones

Ans. D

Explanation:

Ans. D: Fluoroquinolones

In occasional cases of chloroquine resistance:

Quinine 600 mg (10 mg/kg) 8 hourly for 7 days + Doxycycline 100 mg daily for 7 days + Primaquine 15 mg (0.25 mg/ kg) daily for 14 days.


Q. 11

Drug of choice for cerebral malaria is:           

March 2010

 A

Chloroquine

 B

Quinine

 C

Primaquine

 D

Sulfadoxine

Q. 11

Drug of choice for cerebral malaria is:           

March 2010

 A

Chloroquine

 B

Quinine

 C

Primaquine

 D

Sulfadoxine

Ans. B

Explanation:

Ans. B: Quinine

Chemotherapy for cerebral malaria (CM) primarily involves the use of quinine, for a patient with severe CM must be assumed to have chloroquine resistance.

It is one of the four main alkaloids found in the bark of the Cinchona tree and is the only drug which over a long period of time has remained largely effective for treating the disease.

Quinine has similar activity to chloroquine in that it is likely to interfere with the parasite’s enzymatic digestion. Artemisinins have been shown to clear parasitemia and fever faster than quinine or chloroquine, but they had no effect on mortality rates.

It is a sesquiterpene lactone derived from Artemisia annua.

The two most widely used are artesunate and artemether.


Q. 12

Antimalarial drug safe in pregnancy is:

September 2006, March 2007

 A

Quinine

 B

primaquine

 C

Artesunate

 D

Chloroquine

Q. 12

Antimalarial drug safe in pregnancy is:

September 2006, March 2007

 A

Quinine

 B

primaquine

 C

Artesunate

 D

Chloroquine

Ans. D

Explanation:

Ans. D: Chloroquine

Chloroquine and proguanil are safer antimalarial drugs in pregnancy.


Q. 13

Not a drug recommended for P. falciparum is ‑

 A

Quinine

 B

Ciprofloxacin

 C

Artemether

 D

Doxycycline

Q. 13

Not a drug recommended for P. falciparum is ‑

 A

Quinine

 B

Ciprofloxacin

 C

Artemether

 D

Doxycycline

Ans. B

Explanation:

Ans. is ‘b’ i.e., Ciprofloxacin


Q. 14

Antimalarial drug used for causal prophylaxis act at which stage of developmental cycle ‑

 A

Gametogony

 B

Erythrocytic schizogony

 C

Pre-erythrocytic schizogony

 D

Exo-erythrocytic schizogony

Q. 14

Antimalarial drug used for causal prophylaxis act at which stage of developmental cycle ‑

 A

Gametogony

 B

Erythrocytic schizogony

 C

Pre-erythrocytic schizogony

 D

Exo-erythrocytic schizogony

Ans. D

Explanation:

Ans. is ‘d’ i.e., Shows cross reactivity with other penicillins

Aztreonam

  • It belongs to monobactams group of 13-lactam antibiotics.
  • It is active against gram negative organisms including pseudomonas, but has no activity against gram positive organisms or anaerobes fi-lactam antibiotic with aminoglycosides spectrum.
  • It is the only fi-lactam antibiotic that lack cross-reactivity with other P-lactam antibiotics, permiting its used in patients allergic to penicillins or cephalosporins.

Q. 15

Drug for prophylaxis of malaria in chloroquine resistant P.falciparum ‑

 A

Mefloquine

 B

Quinine

 C

Halofantrine

 D

Artesunate

Q. 15

Drug for prophylaxis of malaria in chloroquine resistant P.falciparum ‑

 A

Mefloquine

 B

Quinine

 C

Halofantrine

 D

Artesunate

Ans. A

Explanation:

Ans. is ‘a’ i.e., Mefloquine 

Chemoprophylaxis of malaria

  • Chemoprophylaxis is recommended for travellers from non-endemic areas, and as a short term measure for soldiers, police and labour forces serving in highly endemic areas.
  • Chemoprophylaxis should begin a week before arrival in malarious area and continued for at least 4 weeks or preferably 6 weeks after leaving malarious area.
  • Drugs used are : ‑

Chloroquine                       →     DOC for chemoprophylaxis in chloroquine sensitive P. falciparum areas.

Atovaquone/Proguanil        →     Used in areas with chloroquine or mefloquine resistant P. falciparum.

Doxycycline                      →      Used in areas with chloroquine or mefloquine resistant P. falciarum.

Mefloquine                       →      Used in areas with chloroquine resistant P. falciparum

Hydroxychloroquine          →      Alternative to chloroquine in areas with chloroquine sensitive P. falciparum



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