Re: Question for the infectious disease gurus -Minority Report
From: Andrew Folley (agfolley@hotmail.com)
Tue Aug 22 18:43:17 2006
Glen
I will take the minority view on this question. I can imagine several
reasons why a woman may want to travel to Viet Nam. My understanding is that
she is not currently prengant?? You have some options to give her. First
suggest if she goes that she try to avoid pregnancy during that time as well
as for 3 months after stopping the malarial prophylaxis.
Secondly I would recommend lariam (Mefloquine) at 250 mg weekly, starting a
week before and for 4 weeks after she returns. Chloroquine would normally
be fine except their is a high incidence of resistance to chloroquine in
Viet Nam. Tetracycline would be reasonable as well on a dailly basis as a
second choice. It is category D whereas Lariam is CAT C I believe.
Also it will be important to know where in Viet Nam she is planning to
travel and for how long.
The chances of acquiring malaria int he major cities of Hanoi and Saigon and
along the coast is negligible and one could argue for not even taking
malaria prophylaxis. Different story in the Central mountain regions
bordering Laos if she is traveling there.
She will also need Tetanus, typhoid, diptheria and Japanese encephalitis
vaccines and Hep A and Hep B. All are safe in pregnancy as they are not
active viruses.
Andrew
ObGyn
Toledo
FACOG
>From: Dr Eberhard Lisse <el@lisse.NA>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: Question for the infectious disease gurus
>Date: Tue, 22 Aug 2006 11:51:06 -0500
>
>Glen,
>
>it's not the drugs, it's the Malaria that you should worry about. She
>should not go there in the first place. Malaria is unpredictable.
>Malaria in pregnancy is a killer. Trust me. Steve and I have extensive
>personal experience with this.
>
>In short, you *REALLY* want to talk her out of going there.
>
>If she is clearly not listening, I would suggest she take Chloroquine
>and Proguanil and as long as she is not pregnant also Doxycyline. If or
>once she is pregnant use Erythromycin instead (on the assumption that
>this is also an inhibitor of protein synthesis and safe in pregnancy).
>
>Then also consider adding 80mg Verapamil three times daily, to lessen
>Chloroquine resistance.
>
>Treatment once infected, Co-Artem, and if that not works immediately,
>Quinine in ICU, the pregnancy is then of no concern to nobody any more
>because the mother will die much earlier.
>
>Mefloquine makes you bonkers, and there is cross-resistance to
>chloroquine, it is highly overrated.
>
>el
>
>on 8/22/06 2:45 PM Elrod, Darryl G Maj 48 MDOS/SGOBO said the following:
> > I have a patient that has been trying to get pregnant. She is currently
> > on bromocriptine for her pituitary microadenoma. She calls today
> > wishing to travel to Vietmam and is told that she needs antimalarial
> > drugs in order to go.
> >
> > The options they have given her are doxycycline or mefloquine.
> >
> > I know doxycycline is a Cat D and mefloquine is Cat C, but what is the
> > risk (if any) of her taking this as prophylaxis in what could
> > potentially be the first weeks of a pregnancy, if she happens to get
> > pregnant on the trip?
> >
> > I can’t find any interactions between bromocriptine and either drug so I
> > think that at least should be fine.
> >
> > Thanks for any help,
> >
> > Glen
> >
> > //SIGNED//
> >
> > D. Glen Elrod, Maj., USAF, MC
> >
> > Obstetrician/Gynecologist
> >
> > Chief of Obstetrics
> >
> > 48 MDOS/SGOBO
> >
> > RAF Lakenheath, England
> >
> > Telephone DSN: 314-226-8130
> >
> > Comm: +44 (0) 1638 52 8130
> >
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>--
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