Medicine for Malaria

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QUESTION

is rotam and maladar malaria medicine?

ANSWER

I have never heard of Rotam, but Maladar is the brand name of a combination sulfadoxine-pyrimethamine, and is used to treat malaria. However, it should be noted that it is not recommended by the World Health Organization as a first-line treatment option, due to concerns about drug resistance, and also lack of efficacy against certain types of malaria.

Instead, first-line recommended treatment is of an artemisinin-based combination therapy, or ACTs, which combine an artemisinin derivative (such as artesunate, artemether or dihyrdoartemisinin) with another anti-malarial drug, such as lumefantrine, piperaquine or mefloquine. Common brand names include Coartem, Lonart and Duo-Cotecxin.

Malaria Cure

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QUESTION

What medicine is good for curing malaria?

ANSWER

There are lots of different types of medication which are effective against malaria. However, for uncomplicated, unsevere cases, the World Health Organization (WHO) recommends using a type of medication called artemisinin-based combination therapy, or ACT. Again, there are many types of ACTs, so the name may vary depending on what is most common in your area, but some widespread brands include Coartem, Lonart, Duo-Cotecxin, etc. In some countries, they are known by an abbreviation of the drug name – for example, in Tanzania, the most common ACT is a combination of artemether and lumefantrine, and the different brands are collectively known as Alu.

For severe or complicated malaria (there is no hard and fast definition, but the clinical diagnosis may include cerebral involvement, seizure, coma, inability to take oral medication, severe anaemia, etc), the WHO recommends intravenous  (IV) artesunate, with quinine as a second choice.

There are also additional forms of treatment which may be used in certain settings, depending on the geographical region and the type of malaria, or if one of the above treatments is not successful. Likewise, pregnant women should not take ACTs, so they need to seek alternative forms of treatment, such as chloroquine (if the local malaria is known to be sensitive), mefloquine or sulfadoxine-pyremethamine.

Malaria Diagnosis

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QUESTION

My body is getting hotter after taking artesunate and mtivitamen tablet, the pain subsides, but later in the evening my body starts getting hotter, I have taken almost four artesunate, yet the body pain and headache refuse to go, pls sir is it malaria or what.

ANSWER

Unfortunately the symptoms of malaria are quite general, and just having a fever could be a sign of malaria but also of many other diseases. You should go to a doctor or clinic to have a blood test—there, they will take some of your blood and look at it under the microscope to determine whether you have malaria parasites in your blood. If you do, they will give you appropriate treatment—it is actually not recommended to take artesunate by itself, and rather it should be taken together with a secondary anti-malarial drug, in a combination known as an artemisinin-based combination therapy (ACT).

Common forms of ACTs available in Africa include artemether-lumefantrine (sold as Alu, Lonart or Coartem) and dihydroartemisinin-piperaquine (sold as Artekin or Duo-Cotecxin). Artesunate comes in combination with amodiaquine, and is often abbreviated as ASAQ.

If you do not get properly diagnosed in a medical facility, you risk treating yourself with unnecessary drugs if in fact you actually have another infection, or you might find you are giving yourself the wrong type of treatment for your malaria infection.

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.

How is Malaria Treated

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QUESTION

How is malaria treated today?

ANSWER

Several different medications exist which are used for the treatment of malaria. The exact drug and method of treatment depends somewhat on the type of malaria the patient is infected with.

In most cases of non-complicated (i.e. when the patient is stable and conscious) malaria, the World Health Organisation recommends an orally-administered (in the form of solid pills) artemisinin-based combination therapy (ACT), such as Coartem (a combination of artemether and lumefantrine). Other types of medication include atovaquone-proguanil (Malarone) and sulfadoxine-pyrimethamine (Fansidar). In some locations, where chloroquine-resistance is not a problem, chloroquine can also be used as a treatment. For complicated malaria, where the patient is in a more severe state, intravenously administered quinine is usually the first-line treatment.

If diagnosed early and the patient is given appropriate medication, virtually all cases of uncomplicated malaria can be effectively treated.

Cure for Malaria

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QUESTION

Is there a cure for Malaria?

ANSWER

Yes. Several different medications exist which are used for the treatment of malaria. The exact drug and method of treatment depends somewhat on the type of malaria the patient is infected with. In most cases of non-complicated (i.e. when the patient is stable and conscious) malaria, the World Health Organisation recommends an orally-administered (in the form of solid pills) artemisinin-based combination therapy (ACT), such as Coartem (a combination of artemether and lumefantrine). Other types of medication include atovaquone-proguanil (Malarone) and sulfadoxine-pyrimethamine (Fansidar). In some locations, where chloroquine-resistance is not a problem, chloroquine can also be used as a treatment. For complicated malaria, where the patient is in a more severe state, intravenously administered quinine is usually the first-line treatment.

If diagnosed early and the patient is given appropriate medication, virtually all cases of uncomplicated malaria can be effectively treated.

Treatment of Malaria in India

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QUESTION

In India how to treat a child and adult suffering from malaria?

ANSWER

Chloroquine-resistant malaria has been observed in India and so the first line drug of choice should be an artemisinin-derivative in combination with another drug (this group of medications are more generally known as “artemisinin-based combination therapies” or ACTs). A common example of this is artemether in combination with lumefantrine, which is marketed as Coartem. Coartem is also used to treat malaria in children over 11 pounds (5 kg) in weight.

Child Has Recurring Malaria

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QUESTION

My two year old daughter was affected by malaria 9 months back we took proper course and also the follow up course of 6 weeks. After 2 months post 6 weeks she was infected again by malaria and now again she is getting fever and fear this could be malaria again.

ANSWER

If you suspect she might have malaria again it is important you go and get her tested immediately, as then the doctor can prescribe appropriate treatment. This is particularly important for young children, as they are most susceptible to severe malaria. You should also try to find out what type of malaria she had/has. Repeated attacks of malaria can occur three ways. The first is re-infection – the first infection was cured by the medication, but then your daughter was exposed to malaria again, through the bite of an infected mosquito. Preventative measures, such as making sure she sleeps under a long-lasting insecticide treated bednet, can help reduce the risk of re-infection. Secondly, it could be what is called “recrudescence” – this is when the treatment brings the number of parasites in the blood below detectable levels, and low enough so that symptoms subside.

However, once the treatment course stops, the parasite is able to replicate in the blood again, and symptoms return. This is rare if the full, proper course of medication is taken – in most circumstances, Coartem (artemether plus lumefantrine) should be the first line of treatment and it is very effective against preventing recrudescence. Finally, there is relapse. This only occurs with two species of malaria: Plasmodium vivax and Plasmodium ovale. In this case, the parasite is cleared from the blood by the treatment, but some parasites escape by laying dormant in the liver. These can then reactivate weeks, months or even years after the initial infection. Normal malaria medication can be given to treat relapses of infection, but an additional drug, called primaquine, should also be given, to kill the remaining dormant liver stages. Your doctor should be able to tell you whether he would recommend this drug for your child – they should also be tested for G6DP deficiency prior to taking the drug.

Malaria in Burkina Faso

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QUESTION

(1)What drug is administered in the first 24 hours after malaria symptoms onset. What side effects have this/these drugs.

(2) I it is not possible to reach a treatment facility etc until 7 days after initial chills, fever etc and there are no symptoms remaining other than tiredness what is the drug of choice?. Local people say it is malaria but there is no diagnostic facility near the location until a week has passed.

The person in question is visiting in Burkina Faso where malaria is endemic. Standard anti malaria treatment was taken, but we are told that this is not always effective.

ANSWER

1) In most parts of sub-Saharan Africa, due to the spread of chloroquine-resistant strains of Plasmodium falciparum (the most widespread and deadly form of malaria), the first-line treatment for uncomplicated malaria infection are artemisinin-based combination therapy (ACTs) drugs, which combine artemisinin or a derivative (such as artemether) with another anti-malarial drug.

One very common combination is artemether with lumefantrine, which is often marketed as Coartem. ACTs have few common side effects, and very few severe ones, but mild side effects which are reported include nausea, dizziness, loss of appetite and vomiting. One severe side effect that has been reported is allergic reaction.

2) If a patient has had suspected malaria but seems to have recovered, they should probably present themselves to a clinic or physician for a blood test. This will determine whether the patient is still currently suffering from malaria; if so, they will probably still be treated with Coartem or another ACT as above. If there is no trace of the malaria parasites in the blood, the patient might want to try a rapid diagnostic test which looks for antibodies to the malaria parasite; this will tell them if they did in fact have malaria before. Some tests can also differentiate between Plasmodium falciparum and other forms of malaria.

This is important because if they test positive for P. vivax or P. ovale, there is a possibility that the malaria parasites are still present in the liver, in a dormant form, even once all the parasites are gone from the blood stream. In this case, the patient may want to consider talking to their doctor about taking primaquine, which kills the dormant liver stages of the parasites.

People with G6PD deficiency cannot take primaquine so in some cases a G6PD deficiency test may be required first. If the patient is found to have had Plasmodium falciparum, but no active infection appears in the blood, they should still monitor their health carefully for several weeks, and perhaps take malaria preventative medication such as doxycycline or Malarone; even after symptoms cease, in some cases a small number of P. falciparum parasites can remain in the blood, at concentrations too low to be seen under the microscope, but which can then flare up at a later date and cause symptoms to reappear. This is called recrudescence; once symptoms reappear, the patient should immediately seek a diagnosis from the doctor to confirm it is malaria, and then take treatment.

Chloroquine Resistant Malaria

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QUESTION

What is chloroquine resistant malaria?

ANSWER

Chloroquine-resistant malaria is exactly what it sounds like—particular types of malaria which are not cured by treatment with chloroquine.

Chloroquine was first discovered in the 1930s in Germany and began to be widely used as an anti-malaria post-World War II, in the late 1940s. However, resistance to the drug also rapidly emerged, with the first cases of Plasmodium falciparum not being cured by administration of chloroquine being reported in the 1950s.

Since then, resistance has spread rapidly (since obviously it is beneficial to the parasite to be resistant, so various mutations conferring this protection have arisen multiple times in different areas in the world and also been passed on preferentially to new generations of malaria parasites), and now chloroquine resistant P. falciparum can be found globally in malaria-endemic areas.

Chloroquine resistance in Plasmodium vivax has also now arisen, though more recently—the first reports came from 1989, in Australia, in travellers returning from Papua New Guinea. Now, chloroquine resistant forms of P. vivax are found in multiple locations in south-east Asia, such as Myanmar and India, as well as from Guyana in South America.

Nowadays, other drugs, and notably ones containing artemisinin-based compounds, are preferentially used to treat uncomplicated malaria and especially in areas where chloroquine resistance is known to occur. However, due to fears of resistance to these compounds also developing, the World Health Organisation recommends that artemisinin-based compounds only be administered in conjunction with other anti-malaria drugs, such as lumefantrine (which in combination with artemether forms the widely-used anti-malarial treatment Coartem). These combinations are known as artemisinin-based combination therapies, or ACTs for short.