QUESTION
My husband has Malaria following a trip to Kenya and has had a fever for three days. We are in Russia and the only drug available at the pharmacy was Fansidar (we also have some Doxcycyclin). He took three Fansidar tablets last night and feels better but the fever has still not completely gone. What should we do? Take more Fansidar? Thanks for your help.
ANSWER
A single dose of three tablets is the correct amount for an adult over 45kg in weight—do not take any more. Unfortunately, Fansidar is not recommended as the first-line drug against malaria any more since many strains of P. falciparum (the most dangerous type of malaria, and the most common type in Kenya) now have resistance to Fansidar. This could be one reason why the treatment is not fully successful, though it could also be that the treatment has worked, but it will take a day or two more before your husband fully recovers.
Make sure your husband takes in plenty of fluids, and anti-inflammatory drugs such as ibuprofen might help with the fever and any aches he could also be suffering from.
If your husband is still feeling sick after a few days, you should try to have another blood test to see if the malaria parasites are still present in his blood. If you, you should try to find an artemisinin-based combination therapy, such as Coartem, Duo-Cotecxin or Alu. These are the most effective medications against malaria that are currently available, and are recommended as first-line treatment by the World Health Organization (for uncomplicated malaria).
Please what would be the combination of choice for someone who cannot take Lumefantrine since it interacts with Metoprolol.
I have asked one of our medical advisors on Malaria.com about your query, and here is his response:
Anyone who ever prescribes a drug should always check for drug interactions. So I am always reluctant to give blanket recommendations about malaria drugs. There are so many drugs currently in use and new ones coming out all the time. This should be a standard part of the practice of medicine. Also it sounds like you are talking about drugs for treatment, not drugs for prevention. If someone has malaria, that by itself is life threatening and needs to be treated. In that situation, it may be best to stop the metoprolol and use whatever drug is needed to treat the malaria. If the metoprolol cannot be stopped, I would try to use the safest most effective malaria treatment medicine I had available to me. In summary, it depends on the situation.
I hope that is helpful.