Lumartem Dosage

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QUESTION

What is the dosage for a toddler who is taking Lumartem tablet?

ANSWER

Lumartem, like many anti-malarial drugs, is dosed by weight. Therefore if your toddler weights 5-15kg, s/he should be give one tablet (containing 20mg of artemether and 120mg of lumefantrine) immediately after diagnosis of malaria, then another tablet 8 hours after the first one, then one tablet every 12 hours after that until the end of the 3rd day (a total of 6 tablets, taken over 6 doses).

For children weighing 15-25kg, the timing of the doses is the same, but each time, give two tablets. Try not to miss a dose, but if you do, give the child the missed dose as soon as you remember, then wait the prescribed time interval (12 hours, usually) before giving the next one. Do not give a double dose.

Malareich for Malaria Treatment

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QUESTION

I was unconscious and fell to the ground. I went to the hospital and the doctor said it was malaria. He gave me malareich which was one dose for the treatment. I want find out if that is the effective medication for this malaria and if the symptoms will never happen again. The one happened when i was a kid,the second happened when i was 21 yrs and now am 28 yrs and it happened again.

ANSWER

Malareich is a known anti-malarial drug, which consists of sulfadoxine-pyrimethamine, and is taken as a single dose. The World Health Organization however no longer recommends sulfadoxine-pyrimethamine drugs as first-line anti-malarials,
preferring people instead to take artemisinin-based combination therapies (ACTs) such as Lonart or Coartem. Moreover,
sulfadoxine-pyrimethamines are not very effective against some types of malaria, namely Plasmodium vivax, so shouldn’t be given without a positive diagnosis of Plasmodium falciparum malaria.

Doxycycline After Malaria Diagnosis

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QUESTION

My daughter is 24 and in rural Uganda for 4 months. She has been diagnosed with malaria (plasmodium falciparum) and is taking treatment now. Treatment is 3 tablets of Neosidar tablets contain of sulfadoxine BP and of pyrimethamine followed tonight and for the next 3 days by 4 tablets of Lumarten in the morning and at bedtime with milk. Lumarten is a mix of artemether and lumefantrine. Her doctor in Entebbe recommended she should stop taking doxycycline: “the doxy is like a lock on the door, and now someone has broken the lock, so it’s better to treat the malaria as it comes (while still using nets, bug spray, long sleeves, etc. to avoid bites) rather than keep taking the doxy every day.”

Should she stop taking doxycycline and should she be taking the Lumarten with milk? Thank you very much.

ANSWER

I am not personally familiar with Lumarten, but these antimalarials are often taken with food. Of more concern is that she has been given a sulfadoxine-pyramethamine treatment—these are no longer recommended as first line treatment against malaria, and so she should just take the artemisinin-based combination therapy (artemether-lumefantrine is such a combination therapy).

In terms of the doxycycline, I do not understand the doctor’s advice. There is no harm in continuing to take doxycycline after having malaria, and in fact it might prevent re-infection! Of course this depends on how long she is still in Uganda for—the doxy must be taken for four weeks after leaving the malarial area, so if she is returning home soon, she should weigh up the continued preventive benefit against the inconvenience of a long continuation of taking the medication. In general, I don’t like the doctor’s attitude that your daughter should just accept continuing infections with malaria, and “treat them as they come.” It’s much better to use all available methods for prevention. One thing to consider is that dairy products inhibit the uptake of doxycycline, so if your daughter was also taking her doxy with milk (some doctors mistakenly advise this, to prevent stomach upsets when taking the medication), that might have been one reason why she still got infected.

Free Medical Care for Malaria

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QUESTION

Can you get free medical help for someone In Nigeria that has malaria?

ANSWER

Theoretically, the Nigerian government should provide basic services, including malaria diagnosis, through primary care clinics which are administered by local government. In addition, Nigeria has recently instituted a National Health Insurance program, which again should assist in providing health care to many sectors of the population. However, in practice, public health care in Nigeria is still hugely underfunded and not very comprehensive—the World Health Organization (WHO) recently ranked it 187 out of 191 country health systems worldwide!

As such, I would be wary of the quality and accuracy of malaria diagnosis and treatment if you obtained it for free in Nigeria—while you might get perfectly decent care, the statistics suggest the chances of this are slim. You would probably be better off looking for a private clinic, where I imagine the cost will still be quite reasonable (especially if you are part of the National Insurance program there) and the quality of care might be more reliable. Having said this, I have no personal direct experience with health care in Nigeria, public or private, so if other readers of this site have other information, please share it in the comments section below.

Which Medication to Take for Malaria Treatment

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QUESTION

Which medicion should we take during malaria?

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.

New Drug Synriam Approved to Treat Malaria in India

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A new drug to treat malaria, Synriam, was launched in India by Ranbaxy Laboratories Limited. The drug will provide additional options for malaria treatment as  traditional drugs become increasingly ineffective against the deadly malarial parasite because of acquired resistance to available medications.

Taken as a tablet once a day for three days, Synriam may be more effective, cheaper, and have fewer side effects and does not have to be taken with food, according to the University of Nebraska Medical Center (UNMC). From 2000 to 2010, Jonathan Vennerstrom, Ph.D., a professor at the UNMC College of Pharmacy, led an international team that created the drug compound that led to the development of Synriam. Developed by Ranbaxy Pharmaceuticals Limited, the medication now is approved for treatment in adults in India. The company also is working to create a children’s formula and make the drug available in Africa, Asia and South America.

“With more than 200 million cases of malaria each year, the potential impact this drug could have on saving and improving lives worldwide is significant,” Dr. Vennerstrom said. “That’s been our goal and now we are at the finish line.

Tim Wells, MMV’s chief scientific officer, said the completion of a phase III study in Indian adults and the approval of the combination by the Indian regulators was a major milestone. “We look forward to more data from patients in Africa and from studies with children, since this is where the vast majority of the disease is,” he said.

Courtney Fletcher, Pharm.D., dean of the UNMC College of Pharmacy, said another benefit of arterolane, the key component in the new drug invented by Dr. Vennerstrom, is it’s a synthetic. “This is an importance advance in antimalaria drugs. Since it’s a synthetic drug, it doesn’t depend on the availability of a natural plant source like some other antimalarials, which also makes it less expensive.”

Dr. Vennerstrom and his team also have developed a second drug candidate that might be even more superior than the first. It currently is being tested in phase II clinical trials by MMV in Bangkok, Thailand.

“This drug candidate seems to stay in the body longer, and therefore it may be possible to use a single dose instead of three doses,” Dr. Vennerstrom said. “We all forget to take our medications from time to time, so compliance becomes much easier when you have a single-dose drug.”

As a child of missionary parents working in Ethiopia, Dr. Vennerstrom took medications to prevent malaria.

Dr. Vennerstrom and his team received more than $12 million in grants from Medicines for Malaria Venture (MMV), a non-profit organization in Geneva, Switzerland. He has been studying malaria for more than 25 years. The research team included scientists at the Swiss Tropical and Public Health Institute in Switzerland and Monash University in Australia. MMV receives about 60 percent of its funding from the Bill and Melinda Gates Foundation.

“We were very fortunate to receive the support for our project from MMV,” he said. “It is always unpredictable whether or not a drug candidate will be successful.”

Source: University of Nebraska Medical Center (UNMC)

Malarial Attack Recurring

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QUESTION

My Father aged 65 years was diagnosed with malaria 15 days back and was on medication. Fever was recurring frequently and he had developed a lung infection. Three days back fever stopped and did not occur for 2 days and malarial infection was reducing. Now the Fever has started coming but other parameters are normal. Can you please suggest what needs to be done?

ANSWER

If your father also developed a lung infection, was he treated with antibiotics? If not, his later fever could be caused by that infection, and could be unrelated to the malaria.

He should have another blood test, to look for the malaria parasites; if they are still present, then you should talk to his doctor about trying another type of anti-malarial medication—the World Health Organization recommends artemisinin-based combination therapies (ACTs), such as Coartem, Alu and Duo-Cotecxin, as the first-line treatment against uncomplicated malaria.

However, given that your father appears to have concurrent other medical conditions, it may be that other treatment is more appropriate, and as such it is very important that you check with your doctor before taking additional medication.

Traditional Methods for Malaria Treatment and Prevention

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QUESTION

What are the traditional methods on treating and preventing malaria?

ANSWER

Many different cultures have had their own traditional ways of treating malaria. Perhaps the two best known come from the native tribes in the Western Amazon basin and the ancient Chinese.

Tribes in the Amazon used the bark of a shrub called Cinchona to treat fevers and shivering; Spanish priests in this region observed traditional Quechua healers using this bark and started using it themselves to treat the fevers associated with malaria. Many centuries later, the active ingredient from this bark was isolated and called quinine, which is still used in the treatment of malaria today.

In ancient China, traditional healers would use the plant sweet wormwood (Artemisia annua, to give it its full Latin name), also to treat fevers and the symptoms of malaria. For many hundreds of years, this traditional cure was forgotten about, until the 1970s when a concerted effort led by Mao Tse-Tung began to search for new anti-malarial compounds as part of their Vietnam war effort. Their scientists, led by Dr Youyou, re-discovered sweet wormwood and extracted a potent anti-malarial compound from it, called artemisinin. This compound and and its many derivatives, in the form of artemisinin-based combination therapies (ACTs), are now the mainstay of the World Health Organization’s first-line recommended treatment against uncomplicated malaria.

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.