Assessment of Long-Term Health Effects of Antimalarial Drugs When Used for Prophylaxis (2020) / Chapter Skim
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Appendix B: Invited Presentations
Appendix B: Invited Presentations
Pages 383-392
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From page 383... ...
, Department of State, and the Peace Corps. In addition to presentations focused on antimalarial drug prophylaxis policies among different government agencies, representatives from the Food and Drug Administration (FDA)
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From page 384... ...
COL Wiesen explained that geographic combatant commanders set the "requirements for entry" for forces serving in their areas; the commanders decide whether and what antimalarial prophylaxis is required based on DoD Health Affairs guidelines, and they may modify requirements as intelligence comes in. The use of a medical product that is not FDA approved requires approval from DoD Health Affairs and must be accomplished via an emergency use authorization process.
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From page 385... ...
(1993) compared taking mefloquine and chloroquine for 1 year by Peace Corps volunteers; there were no serious adverse reactions, and the frequency of mild adverse events was the same across the two drugs.
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From page 386... ...
Tan observed that there is an evidence gap for studies of the long-term health effects of long-term malaria prophylaxis; of the available data, the Peace Corps and military data are the strongest. Literature on the safety of malaria prophylaxis in pregnant women and in children is also limited.
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From page 387... ...
falciparum exists. The 2014 technical guidelines state that there is no first-line prophylactic malaria drug and that the Peace Corps medical officers who provide primary care to volunteers should individualize prophylaxis selection to the volunteer.
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From page 388... ...
and limited long-term safety data mean it cannot yet be used to completely replace mefloquine in the Department of State population. Thomas Brewer, Ph.D., described to the committee experimental work being done on the neurotoxicity of antimalarial drugs.
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From page 389... ...
Additional, focused toxicity studies using dogs, rats, mice, and monkeys using lactate dehydrogenase as the marker of cell death were conducted to explain the deaths; the deaths were traced to central nervous system actions, which were identified as a circumscribed toxicity limited to the brainstem, with lesions in the auditory vestibular nucleus and in the reticular and the visceral autonomic brainstem nuclei. The artemisinin analogs showed an increase in lactate dehydrogenase in situ in some of the dogs, indicating selective neuronal damage in these brainstem neurons.
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From page 390... ...
When auditory performance was suppressed, rats also showed gross behavioral signs of toxicity that included tremor, gait disturbances, and lethargy with arteether treatment. Subsequent histologic assessment of arteether-treated rats revealed marked damage in the brainstem nuclei, ruber, superior olive, trapezoideus, and inferior vestibular.
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From page 391... ...
2017. Long-term health outcomes among returned Peace Corps volunteers after malaria prophylaxis, 1995-2014.
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