FMGE 2021 — Pharmacology

Question 1: A patient from a North-Eastern state was diagnosed to have an infection with P. Falciparum malaria. What is the most appropriate treatment for this patient?

• A. Chloroquine
• B. Mefloquine
• C. Sulfadoxine plus pyrimethamine
• D. Artemether plus lumefantrine (Correct Answer)
• E. Quinine plus doxycycline

Explanation: ***Artemether plus lumefantrine*** - Artemether-lumefantrine is the recommended first-line treatment for **uncomplicated P. falciparum malaria** in regions with known **chloroquine resistance**, such as North-Eastern India. - This combination therapy, an **Artemisinin-based Combination Therapy (ACT)**, is highly effective due to its rapid parasiticidal action and synergy. *Chloroquine* - Chloroquine resistance in **P. falciparum malaria** is widespread, particularly in many parts of India, including the North East. - Using chloroquine alone would likely lead to **treatment failure** and worsening of the patient's condition. *Mefloquine* - Mefloquine is an alternative treatment option, but it has significant drawbacks including **neuropsychiatric side effects** (e.g., anxiety, depression, hallucinations) and a long half-life. - It is often reserved for specific situations or as a second-line agent when ACTs are not available or contraindicated. *Sulfadoxine plus pyrimethamine* - **Sulfadoxine-pyrimethamine (SP)** is an older antimalarial drug combination that is not recommended as first-line treatment for **uncomplicated P. falciparum malaria** due to widespread **parasite resistance**. - While it was formerly used for prophylaxis and intermittent presumptive treatment, its efficacy against P. falciparum has significantly declined. *Quinine plus doxycycline* - **Quinine plus doxycycline** is an effective alternative for treating **P. falciparum malaria**, particularly in **severe cases** or when ACTs are contraindicated or unavailable. - However, it is **not the first-line treatment** for uncomplicated malaria due to longer treatment duration (7 days), more frequent dosing, and potential side effects (cinchonism, GI disturbances). - Requires adherence to a multi-day regimen, making ACTs more practical for uncomplicated cases.