Injections for Malaria Treatment?

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QUESTION

I have a friend that just told me that she has Malaria. She said she has to go to the hospital every day for an injection for around the next 2 weeks. Is this a typical treatment. Why not just take pills? I`m just trying to wrap my head around this and understand the different treatments.

ANSWER

This is certainly not typical treatment for malaria. Uncomplicated malaria is usually treated with oral medication, and the type depends on the type of malaria you have. The most severe form of malaria, Plasmodium falciparum, is often resistant to chloroquine (still the first-line drug of choice for P. malariae, P. knowlesi and P. ovale infections, as well as for P. vivax in most parts of the world) and so first-line treatment is now usually an artemisinin-based combination therapy (ACT), such as Coartem.

As far as I am aware, it is only in cases of complicated, severe malaria that intravenous or intramuscular treatment is used (usually quinine), and in those cases, treatment would not be administered on an outpatient basis. It may be that your friend has a specific medical requirement for a non-oral form of medication, but it is definitely unusual!

How is Malaria Cured?

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QUESTION

How is malaria cured?

ANSWER

Malaria can be cured with a number of different medications, depending on then type of malaria and how far the disease has been progressed.

For standard, non-complicated Plasmodium falciparum malaria, the World Health Organisation recommends use of artemisinin-based combination therapies (ACTs), such as Coartem. This is due to increasing levels of resistance to chloroquine in many parts of the world. Indeed, even though chloroquine is still used in many places as first-line treatment against P. vivax, P. malariae, P. ovale and P. knowlesi uncomplicated malaria, there is some evidence that resistance to this treatment is also emerging, for example in P. vivax in parts of south-east Asia.

In cases where malaria infection has progressed to a stage where oral administration of medication is not possible, or where cerebral symptoms are suspected, the usual treatment option is intravenous quinine.

In addition, P. vivax and P. ovale malaria parasites are able to produce forms (called hypnozoites) which can become dormant in liver hepatocyte cells after the blood stages of the infection have been cleared. These dormant forms can become reactivated weeks or even months or years after the initial infection, which is called a “relapse” of the infection. One drug, called primaquine, is able to kill these liver stages, and so patients with either of these types of malaria should also discuss the possibility of taking primaquine.

Apart from these first-line treatments, there are other medications which are used against malaria, both prophylactically as well as for treatment. These include orally-administered quinine, pyrimethamine, mefloquine, proguanil, atovaquone and sulfonamides.

For more information, see the WHO recommendations for malaria treatment.

Paludisme Depuis 5 Mois (Malaria for 5 Months)

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QUESTION:

En fait je souffre d’un palu que le médécin a mal traité après une analyse sanguine. J’aimerais savoir comment faire pour m’en débarrasser car je traine ce palu maitenant depuis 5 mois.

ENGLISH TRANSLATION:

In fact I suffer from malaria which the doctor has treated poorly after a blood test. I would like to know how to clear myself of this because I have been carrying this malaria now for 5 months.

ANSWER:

C’est rare de souffre telle longtemps que 5 mois continuellement avec palu; plus commun c’est de observer plusieurs episodes d’infection en serie, si la traitement n’est-ce pas un succes. Mais tout ca depend un peu du type du palu. Vous devrez tenir un autre test sanguine pour determiner ce type du palu, de preference au hôpital ou dans un clinique de santé. Avec celle information, le médécin peut vous recommender un traitement approprié. Par example, si vous avez un infection de Plasmodium vivax ou P. ovale, le parasite peut rester en repos dans le foie pendant plusieurs semaines ou bien plusieurs mois. Des médicaments qui traitent l’infection dans le sang, comme chloroquine ou ACTs, ne touchent pas cette stages de vie dans le foie. Dans ce cas, vous devez parler avec votre médécin sur un autre médicament, qui s’appelle primaquine, qui tue a les parasites dans le foie et previent encore plus de rechutes.

ENGLISH TRANSLATION: It’s rare to suffer from malaria continuously for five months; it is more common to see multiple infections over and over in series, if the disease is not treated appropriately. But all of this depends on the type of malaria that you have. You need to have another blood test to determine the type of malaria, and based on this information, the doctor can give you appropriate treatment. For example, if you have Plasmodium vivax or P. ovale, the parasite can rest dormant in the liver for several weeks or even months. The drugs which treat the initial infection in the blood, such as chloroquine or ACTs, don’t affect these liver stages. In this case, you must talk to your doctor about taking another medication, called primaquine, which kills the liver stages of the malaria parasite and prevents further relapses of the disease.

I am getting malaria every 6 months

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QUESTION:

I am getting malaria every six months, after taken chloroquine medicine tablets. Is this  normal,when my resistance is low, or is it coming aging, is there any medicine to clear the malaria?

ANSWER:

While taking chloroquine can be used to treat malaria, it will not prevent re-infection, unfortunately. One thing to check though is whether you are living in an area where the local types of malaria might be resistant to chloroquine; if so, it will be worth seeing if you can be treated with artemisinin-based combination therapies (ACTs), such as Coartem or Lonart, instead.

Again, these will not prevent re-infection, however, so you need to also take other preventative actions, such as sleeping under a long-lasting insecticide treated bednet and wearing long-sleeved clothing in the evenings and at night to prevent mosquito bites.

It sounds from your question like you live in an area where malaria is common; however, if you are actually only travelling to malarial areas regularly, you could also ask your doctor about the possibility of taking preventative medicine against malaria for the time that you are travelling (these are called “prophylactics”).

You should also check which species of malaria parasite you are infected with – this can be determined when you are diagnosed with the infection, either through looking at your blood under a microscope or by using a rapid diagnostic test (RDT). If you Plasmodium ovale or Plasmodium vivax, there is a possibility that even though the initial acute phase of the infection is responding to treatment with chloroquine, the parasite is remaining dormant in your liver, and causing the recurrences every 6 months. In this case, you should ask your doctor about the possibility of taking a drug called primaquine, which kills these liver stages and prevents further relapse of the disease.

ARCEVA for malaria

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QUESTION:

Is ARCEVA a good vaccine for malaria?

ANSWER:

ARCEVA isn’t a vaccine for malaria, but it is a brand name of one type of medication used to treat the disease. It belongs to the group of drugs called artemisinin-based combination therapies (ACTs), which are recommended by the World Health Organisation to treat uncomplicated malaria caused by Plasmodium falciparum, the most dangerous form of malaria. ARCEVA specifically contains artemether combined with lumefantrine. It is very important to know that there is no effective vaccine against malaria that is currently available; many scientists and researchers are vigorously hunting for such a vaccine, knowing that this would radically decrease the number of cases of malaria worldwide.

Drugs to Treat Pregnant Woman with Malaria

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QUESTION:

What are the drugs for a pregnant woman who has malaria for the first to third trimester?

ANSWER:

The treatment of malaria in pregnant women has become more challenging in recent years, as many types of malaria are developing resistance to the standard arsenal of drugs. In locations where the dominant form of malaria is still chloroquine-sensitive, chloroquine can be used safely throughout pregnancy.

However, given the high levels of chloroquine-resistance, other drug regimens may be required. Currently, first-line treatment options for uncomplicated malaria caused by Plasmodium falciparum (many strains of which are resistant to chloroquine), is quinine plus clindamycin (doxycycline is contraindicated in pregnant women). In the second and third trimesters, artesunate plus clindamycin can be administered, or the artemisinin-based combination therapy (ACT) commonly used in that region, although some of these combinations, particularly those containing artemether, have limited safety testing in pregnant women. In general, the paucity of controlled, randomized trials has posed a problem to creating safe and effective recommendations for the treatment of malaria in pregnant women.

Causes of malaria, treatment with drugs and emerging resistance

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QUESTION:

What is malaria and what causes it besides bacteria? What is the name of the causal agent for malaria, which drug is used to cure it and how do the pathogens become resistant to the drugs?

ANSWER:

There are many questions in there! Malaria is actually caused by a single-celled animal, called a protozoan; it’s not a bacterial disease. There are different species of these protozoans, which form a genus called Plasmodium; the different species cause different types of malaria, for example Plasmodium falciparum, the most deadly and severe form, and Plasmodium vivax, which is widespread throughout the world but is a less acute infection. These different forms of malaria are each treated with different medications, depending on what is most effective and available; P. vivax, for example, can be treated with chloroquine, whereas in many places, P. falciparum has become resistant to this drug. In areas where resistance to chloroquine has emerged, other drugs are used; in Africa, artemisinin-based combination therapies (ACTs) are commonly used against chloroquine-resistant P. falciparum. Other drugs used to treat malaria include quinine compounds such as quinine sulphate, mefloquine, sulfadoxine-pyrimethamine and medications combining proguanil with atovaquone (marketed as Malarone).

The emergence of resistance to these drugs is a worrying phenomenon with respect to malaria; it is such a widespread and deadly disease, that the consequences of failed treatment are very high. Resistance can be caused by many factors, at the level of the drug, the human host, the mosquito host and also the malaria parasite itself. For example, poor drug compliance during treatment can lead to a failure to clear an infection completely, allowing the remaining parasites, which were less susceptible to the drug, to survive and reproduce. With successive generations, natural selection will lead to the evolution of strains of malaria parasites which are firmly resistant to that drug. The same process occurs when mass drug administration programmes, for example in areas of high malaria endemicity, give people sub-therapeutic doses of medication (in other words, doses of the drug that are too low to kill the parasite). Another problem is when people are not checked for their infection status after having been treated for malaria; if treatment fails for some reason, they will still have parasites in their blood, and should be treated again to ensure that all the malaria has been killed. If this doesn’t happen, the parasites can carry on reproducing, as in the processes described above. For these reasons, it is crucially important for people to be given accurate doses of medication, to ensure that they complete the full course of treatment, and that once treatment has been completed, they are accurately tested as negative for the malaria parasite. Finally, there are factors related to the affinity of the malaria parasite to its vector mosquito hosts which can lead to the emergence of drug resistant strains. For example, it has been shown that strains of malaria which are resistant to chloroquine are better able to survive and reproduce inside their mosquito hosts, leading to a greater population size of resistant parasites compared to drug-susceptible ones. It is for these reasons that malaria treatment and control programmes are now being very careful with the ways in which they administer drugs and monitor infections, in order to limit any further reisstance developing; similarly, pharmaceutical and biochemical researchers are constantly on the look-out for new compounds or methods of killing malaria parasites, which can be developed into new forms of treatment.