Malaria Treatment and Prevention Methods

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QUESTION

I work in Central Africa republic.I was recently diagnosed with malaria (p.falciparum) after a blood test—my 4th attack in 15 months and given Co-Arinate. Two days after completing my dose I went for a 2nd blood test and the trophozoite count was 720/mm3.

The doctor prescribed co-artem and said if I don’t get better he shall transfuse quinine. Whats your comment on the treatment? Do these malaria medications/attacks have a long term effect on ones liver? What prophylaxis should I consider to prevent future attacks.

ANSWER

I will forward your question on to one of the medical professional who advises our website. However, normal procedure after treatment failure or incomplete treatment with one type of anti-malarial medication would be to try another type of medication first; Co-Arinate might not have been an ideal first choice given that many types of malaria around the world are showing signs of resistance to pyrimethamine, the combination drug in Co-Arinate.

Co-Artem would be a better first choice drug, given that there is no convincing evidence for resistance to its combination compound, lumefantrine. Quinine could be a potential next step though I would imagine Co-Artem will be successful—make sure the drugs have not expired and are in their original packaging, as counterfeit medication is a problem in many parts of the world.

Regarding prevention, a key method is to sleep under a long-lasting insecticide treated bednet; make sure it is re-dipped in insecticide every year or so to maintain its efficacy. The mosquitoes which transmit malaria tend to feed at night, and so protecting yourself and your home during the evening, night and early morning is crucial. Maintaining good screens on all windows and doors can be a very effective way of preventing mosquitoes from entering, and in many parts of the world, people spray inside with insecticides to reduce the number of mosquitoes yet further. Wearing long-sleeved clothing at night and in the evenings can also prevent bites.

More broadly speaking, you can try to make sure that stagnant water sources, such as empty containers or barrels, are removed, as mosquitoes require still water to breed. Reducing the presence of stagnant water will therefore reduce mosquito numbers; treating standing water with larvacides or adding fish that eat mosquito larvae can also help.

How is Malaria Treated

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QUESTION

How is malaria treated?

ANSWER

This answer is copied from an earlier question about the various available cures for malaria.

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.

 

How is Malaria Cured?

by

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.