Malaria Treatment and Prevention Methods

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QUESTION

I work in Central Africa republic.I was recently diagnosed with malaria (p.falciparum) after a blood test—my 4th attack in 15 months and given Co-Arinate. Two days after completing my dose I went for a 2nd blood test and the trophozoite count was 720/mm3.

The doctor prescribed co-artem and said if I don’t get better he shall transfuse quinine. Whats your comment on the treatment? Do these malaria medications/attacks have a long term effect on ones liver? What prophylaxis should I consider to prevent future attacks.

ANSWER

I will forward your question on to one of the medical professional who advises our website. However, normal procedure after treatment failure or incomplete treatment with one type of anti-malarial medication would be to try another type of medication first; Co-Arinate might not have been an ideal first choice given that many types of malaria around the world are showing signs of resistance to pyrimethamine, the combination drug in Co-Arinate.

Co-Artem would be a better first choice drug, given that there is no convincing evidence for resistance to its combination compound, lumefantrine. Quinine could be a potential next step though I would imagine Co-Artem will be successful—make sure the drugs have not expired and are in their original packaging, as counterfeit medication is a problem in many parts of the world.

Regarding prevention, a key method is to sleep under a long-lasting insecticide treated bednet; make sure it is re-dipped in insecticide every year or so to maintain its efficacy. The mosquitoes which transmit malaria tend to feed at night, and so protecting yourself and your home during the evening, night and early morning is crucial. Maintaining good screens on all windows and doors can be a very effective way of preventing mosquitoes from entering, and in many parts of the world, people spray inside with insecticides to reduce the number of mosquitoes yet further. Wearing long-sleeved clothing at night and in the evenings can also prevent bites.

More broadly speaking, you can try to make sure that stagnant water sources, such as empty containers or barrels, are removed, as mosquitoes require still water to breed. Reducing the presence of stagnant water will therefore reduce mosquito numbers; treating standing water with larvacides or adding fish that eat mosquito larvae can also help.

Chewable Malaria Medication

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QUESTION

Can this drug be chewed by an older person who can not swallow drugs?

ANSWER

Some malaria medication can be administered via injection. In places where malaria is still resistant to chloroquine, a syrup formulation is sometimes given to children who are unable to swallow tablets, so this might be an effective solution. Otherwise, you can talk to your doctor about the efficacy of the tablets if chewed—I imagine they will probably be fine, though they won’t taste very good!

Malaria in Ivory Coast

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QUESTION

I am going to work in the Ivory Coast on an oil and gas platform out at sea I will be in the Ivory Coast for about 30 Days and home for 26 Days and back in the Ivory Coast for 30 Days this could go on for a couple of years. What would you suggest that I take for anti malaria? Would O need a prescription or can I get it from the chemist?

ANSWER
You usually need a prescription to get anti-malarials. None of the available anti-malarials are really recommended for long-term use, except possibly for doxycycline, and since that one requires you to take for four weeks after you have left the malarial area, you might find yourself taking a pill every day for several years! Some people on doxycycline experience sun sensitivity as a side effect, which means it might not be the best choice for people working outdoors in the tropics.

Likewise, Lariam must be taken for four weeks after leaving the malarial area, but is only taken weekly, so it might be more convenient. Lariam is unsuitable for people with certain psychiatric disorders, and many people report side effects such as anxiety and increased aggression. Moreover, I am not sure what the recommendations are regarding long term use.

Malarone (atovaquone-proguanil) is convenient in that it only has to be taken for one week after leaving a malarial area, but again it is a daily pill, and while it probably has the least number of side effects, it is also the most expensive, and could be prohibitively so for long term use.

So, as you can see, there are pros and cons with all the main forms of preventive anti-malarial medications! Since you will be working out at sea, I actually wonder how great the risk of malaria actually is—the mosquitoes which carry the malaria parasite require stagnant freshwater in order to breed, and so if the platform does not contain these areas of still freshwater and if you are sufficiently off-shore so that mosquitoes cannot fly readily from the mainland, you may actually find there is not very much malaria there, and you will only be at risk if and when you visit the mainland.

In those cases, you could look into taking Malarone or another type of medication to protect you when you are on the mainland. In addition, for peace of mind, while on the rig you could use other types of prevention against malaria, such as sleeping under a long-lasting insecticide treated bednet at night and taking care not to be bitten by any mosquitoes that might be around.

As such, I would advise you trying to find out how far the platform is from the mainland and whether there is known malarial risk there. If there is, then you should talk to your doctor about the above anti-malarial drugs and decide which one would be best for you, if any—like bednets, there are also measures you can take to protect yourself from mosquitoes which can also be very effective is used regularly and correctly.

Malaria in South Africa

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QUESTION

What are the high, low and no-risk areas for malaria in South Africa?

ANSWER

Malaria has been successfully controlled in many parts of South Africa, with the result that most of the country is not at risk for malaria transmission. However, some pockets of higher risk remain in the north-eastern corner of South Africa (north-eastern KwaZulu-Natal, with the southern-most limit of transmission corresponding with the Tugela River, Limpopo (Northern) Province, and Mpumalanga Province). Malaria is also transmitted in Kruger National Park.

How is Malaria Treated

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QUESTION

how is malaria treated?

ANSWER

Malaria can be a severe, potentially fatal disease (especially when caused by Plasmodium falciparum) and treatment should be initiated as soon as possible.

Patients who have severe P. falciparum malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion.

Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include:

  • chloroquine
  • atovaquone-proguanil (Malarone®)
  • artemether-lumefantrine (Coartem®)
  • mefloquine (Lariam®)
  • quinine
  • quinidine
  • doxycycline (used in combination with quinine)
  • clindamycin (used in combination with quinine)
  • artesunate (not licensed for use in the United States, but available through the CDC malaria hotline)

In addition, primaquine is active against the dormant parasite liver forms (hypnozoites) and prevents relapses. Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase). Patients should not take primaquine until a screening test has excluded G6PD deficiency.

How to treat a patient with malaria depends on:

  • The type (species) of the infecting parasite
  • The area where the infection was acquired and its drug-resistance status
  • The clinical status of the patient
  • Any accompanying illness or condition
  • Pregnancy
  • Drug allergies, or other medications taken by the patient

If you have or suspect you have malaria, you should contact your doctor immediately.

Treatment Duration of Lumartem

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QUESTION

I am on the lumartem treatment. I started at 8am to 4 pm. then 4am. i forgot to take the drugs at 4pm, but took it at 8;30o. Should I start all over or continue at 4am or 8 am?

ANSWER

If you miss a tablet, you should take the next one as soon as you remember, then wait the required interval before taking the pill after that. So, since you took the missed pill at 8.30, you should take the following one at 8.30am (12 hours later). Then continue as you would normally until all 6 doses have been taken – it is very important to complete the full course of tablets.

Transmission of Malaria from Person to Person

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QUESTION

I was in Lagos, Nigeria and i was bitten. I had stomach ache and diarrhea for a day then back to normal. Just for precaution I checked my blood and the doc said that I have a mild malaria in my blood and he gave me a medicine. If i have malaria can I affect or transmit the malaria to other people like my friends or my wife by the saliva or by any means?

ANSWER

No, you cannot directly transmit malaria to other people. It can only be transmitted via the bite of an infected mosquito; as such, while you are recovering from malaria, you should take care not to be bitten by any mosquitoes, because if these mosquitoes then went on to bite someone else, they might get infected with malaria.

Since malaria infects the blood, if large amounts of blood are transferred between people, for example during a blood transfusion, organ transplant or during childbirth, then malaria can sometimes also be transmitted. But under normal circumstances, you can not directly transfer malaria to another person.

Treatment of recurrent Malaria

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QUESTION

If one takes the first dose of Coartem and tests indicate presence of malaria parasites,is it advisable to take a second round of coartem, or to start on quinine? Is quinine usually administered on its own or in conjunction with another drug? At what point is malaria considered complicated?

ANSWER

Usually, if a first round of treatment is unsuccessful, a doctor will prescribe a different type of oral medication for another attempt, such as atovaquone-proguanil or doxycycline in combination with another anti-malarial.

Quinine, when administered orally, can be given alone but is more commonly given with another anti-malarial compound such as doxycycline, tetracycline or clindamycin.

In cases of complicated malaria, it is administered intravenously. There are a number of symptoms which, in combination with a history of high fever, define complicated/severe malaria, among which are:

  • Prostration (inability to sit), altered consciousness lethargy or coma
  • Breathing difficulties
  • Severe anaemia
  • Generalized convulsions/fits
  • Inability to drink/vomiting
  • Dark and/or limited production of urine

In addition, intravenous quinine may be given to patients who are unable to take oral medication for whatever reason.

Dormant Malaria

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QUESTION

I was bitten by mosquitoes many years ago and I was wondering can the symptoms lie dormant for as long as 40 years? The reason I am asking is that every summer I am ill with several of these symptoms. I do not have a good immune system.

ANSWER

There are a couple of types of malaria, namely Plasmodium vivax and Plasmodium ovale, which can lie dormant for many years, and often cause relapses at regular intervals.

Next time you suffer from these symptoms, you should go to your doctor and have a blood test to check for malaria; while you are experiencing symptoms, if you have malaria, the parasites will be visible in your blood.

Once positively diagnosed, your doctor can provide you with treatment. If you do have malaria, you will need one medication to clear the infection from your blood (which kind depends on where you were when you got those mosquito bites; malaria has become resistant to certain types of medication in some areas), plus another type of medication to kill the dormant forms which are responsible for the yearly relapses. This latter medication is called primaquine, and is not recommended for people with G6DP deficiency, so you should be tested for this prior to taking the medication.

Having said all of that, it is very important to get the blood test if you suspect you have malaria, because the symptoms of malaria are very general (fever, chills, nausea, aches) and can be mistaken for many other illnesses. If your blood test is negative for malaria, then you should talk to your doctor about other possible infections.