Tropical Splenomegaly Syndrome Medication

  • Author: Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP; Chief Editor: Robert J Arceci, MD, PhD   more...
 
Updated: May 9, 2012
 

Medication Summary

Antimalarial drugs are effective in treating hyperreactive malarial syndrome (HMS). The specific drug of choice is based on the pattern and prevalence of drug resistance in the patient's geographic area. In endemic areas, treatment should be prolonged and continued regularly. Months may pass before a response is observed, and relapses may occur when therapy is discontinued.

In expatriates returning with HMS, brief courses of treatment may be adequate.[18] To the authors' knowledge, no studies have addressed the duration of adequate treatment, and no researchers have compared antimalarial medications.

Chloroquine and proguanil appear to be equally effective. This observation suggests that eradication of parasitemia is the common pathway for therapeutic responses. Pyrimethamine may be an alternative.[24] Data regarding the usefulness of other antimalarial drugs in HMS are limited.

Short-term antimalarial treatment may be sufficient to treat patients who reside outside of an endemic region. The role of lifelong prophylaxis for individuals residing in endemic areas is unclear. Treatment may last more than one year or even longer.

The response to therapy is guided by the size of spleen, a decrease in serum IgM levels, improvement of anemia, and general improvement in the patient's well-being.

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Antimalarial Agents

Class Summary

Because epidemiologic and other data suggest that HMS is related to malarial infection, antimalarial drugs have been used and have been effective.

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Chloroquine phosphate (Aralen Phosphate)

 

4-aminoquinolone widely used to treat malaria until recently, when resistant strains became major problems. Chloroquine and related drugs gametocidal (for species except for P falciparum) and schizonticidal (for parasites in blood but not tissue).

Well absorbed PO. Best taken with food to decrease GI distress.

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Proguanil (Paludrine)

 

Not available as single component in United States. Not prompt in relieving symptoms of acute malaria, but proguanil and related drugs (eg, pyrimethamine) effective against erythrocytic stages of malaria; they inhibit tetrahydrofolate dehydrogenase. Resistance to this group of drugs develops quickly.

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Pyrimethamine and sulfadoxine (Fansidar)

 

Combination product containing sulfadoxine 500 mg and 25 mg pyrimethamine. Mechanism of action for pyrimethamine same as that of proguanil (ie, inhibits dihydrofolate reductase). Pyrimethamine therapy, perhaps shortened, may rapidly decrease size of spleen.

Sulfonamides act in synergy with pyrimethamine; used together. Administer with folinic acid to decrease adverse effects.

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Contributor Information and Disclosures
Author

Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP  Associate Professor of Pediatric Hematology and Oncology, Department of Pediatrics, Albany Medical Center; Faculty, Alden March Bioethics Institute

Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and Royal College of Physicians of the United Kingdom

Disclosure: Nothing to disclose.

Coauthor(s)

Mundeep K Kainth, DO  Resident Physician, Department of Pediatrics, The Children's Hospital at Albany Medical Center

Mundeep K Kainth, DO is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

J Martin Johnston, MD  Associate Professor of Pediatrics, Mercer University School of Medicine; Director of Hematology/Oncology, The Children's Hospital at Memorial University Medical Center; Consulting Oncologist/Hematologist, St Damien's Pediatric Hospital

J Martin Johnston, MD is a member of the following medical societies: American Academy of Pediatrics and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

James L Harper, MD  Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Assistant Clinical Professor, Department of Pediatrics, Creighton University School of Medicine; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center

James L Harper, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Federation for Clinical Research, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Council on Medical Student Education in Pediatrics, and Hemophilia and Thrombosis Research Society

Disclosure: Nothing to disclose.

Helen SI Chan, MBBS, FRCP(C), FAAP  Associate Senior Scientist, Research Institute; Professor, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto Faculty of Medicine, Canada

Helen SI Chan, MBBS, FRCP(C), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Robert J Arceci, MD, PhD  King Fahd Professor of Pediatric Oncology, Professor of Pediatrics, Oncology and the Cellular and Molecular Medicine Graduate Program, Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine

Robert J Arceci, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Mudra Kumar, MD, MBBS, to the original writing and development of this article.

References

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