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.