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 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.