infections
Malaria
Treatment of Malaria
Medications to treat malaria After beginning treatment of malaria, most people improve within 24 to 48 hours, but with malaria due toPlasmodium falciparum, fever can persist for 5 days. For treatment of acute malaria, the choice of medication is based on The person's symptoms The infecting species ofPlasmodium The likelihood that the parasite is resistant Whether the parasite is likely to be resistant varies with ThePlasmodiumspecies The geographic location where people were infected The treatment regimen is based on the results of the diagnostic tests and site of exposure. However, if doctors strongly suspect malaria, they may treat people for malaria even when the test results do not confirm the diagnosis because tests do not detects all cases, and if untreated, malaria can be life threatening. Doctors measure the person's the blood sugar (glucose) level, particularly in falciparum malaria, and give glucose if the level falls below normal. Because malaria is potentially life-threatening, people are treated immediately. Most cases of malaria can be treated with oral medications. In people who are unable to take medications by mouth,artesunatecan be given intravenously. Severe malaria (seeCenters for Disease Control and Prevention (CDC): Severe Malariafor criteria) requires urgent treatment, preferably withartesunategiven intravenously. Whenartesunateis not immediately available, interim oral treatment with artemether-lumefantrine,atovaquone-proguanil,quininesulfate (plusdoxycyclineorclindamycinintravenously), or if nothing else is available,mefloquineis begun by mouth or with crushed pills delivered through a feeding tube in those who cannot take medications orally. In some areas where malaria is common, antimalarial medications sold by local pharmacies may be counterfeit. Thus, doctors may advise travelers to remote, high-risk areas to take along a full course of the appropriate antimalarial medications. These medications are to be used if a local doctor confirms that the traveler has malaria. This strategy ensures that effective medications are used and avoids depleting limited availability of medications in the country being visited. Commonly used treatments that are taken by mouth include Artemether-lumefantrine Atovaquone-proguanil for malaria without complications Medications that were developed from artemisinin (such as artemether andartesunate) are now used throughout the world to treat malaria due toPlasmodium falciparumor otherPlasmodiumspecies. Artemisinin is derived from a Chinese medicinal herbal called qinghaosu, which comes from the sweet wormwood plant. Some artemisinin medications are given by mouth, and others are given by injection or suppository. None stays in the body long enough to be used for prevention of malaria. However, these medications are useful for treatment because they act more rapidly than other antimalarial medications and are generally well-tolerated. They are given with a second medication to prevent development of drug resistance. One such drug combination is artemether and lumefantrine (given in one tablet). This combination is used all over the world and is the preferred treatment in the United States. When intravenous therapy is needed for severe malaria or for persons who are unable to take medications by mouth,artesunateis the preferred treatment until oral therapy can be started. When there are no complications, malaria due toPlasmodium falciparummay be treated with the combination ofatovaquoneand proguanil. Chloroquineis an option forPlasmodium falciparummalaria in Haiti, Dominican Republic, Central America west and north of the Panama Canal, and parts of the Middle East. However, resistance tochloroquineis now widespread amongP. falciparumelsewhere in the world. Quinineplus either the antibioticdoxycyclineor sometimesclindamycinwas once widely used, but artemether-lumefantrine andatovaquone-proguanil have fewer side effects. These drug combinations have largely replaced treatments that involvequinine. Mefloquinegiven in higher doses than those recommended for prevention is an alternative, but it is used only when other options are unavailable because of its potentially severe psychiatric and other side effects. Also, resistance is now widespread in Southeast Asia and reported in some other areas. Due to the risk of progression to severe disease in patients withPlasmodium falciparuminfection, people are hospitalized to be monitored until symptoms improve and parasite density decreases. Chloroquine(orhydroxychloroquine) remains an effective choice forP. vivaxandP. ovaleinfections except forP. vivaxinfections acquired in countries with high prevalence ofchloroquine-resistantP. vivax(seeCenters for Disease Control and Prevention (CDC): Treatment of Malaria). In these areas, people are treated with artemether-lumefantrine oratovaquone-proguanil. taken as a single dose in adults (16 years of age and older), is given at the end of treatment to prevent recurring attacks of malaria. Both medications kill persistent parasites in the liver. Before they are started, a blood test is done to check for Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency . In people with this enzyme deficiency, both Plasmodium malariaeandPlasmodium knowlesiare susceptible tochloroquine. The medications and drug combinations used to treat malaria due toPlasmodium falciparumthat is resistant tochloroquineare also effective in treating malaria due to these species. They do not have persistent parasites in the liver. Artemisinin medications(such as artemether andartesunate) sometimes have side effects, which include headache, loss of appetite, dizziness, and weakness. When the combination of artemether-lumefantrine is used, lumefantrine can interact with other medications, sometimes causing an abnormal heart rhythm. So people should make sure their doctor knows all the medications they are taking so that drug-drug interactions can be avoided. Breakdown of red blood cells and anemia can occur in the weeks following administration ofartesunateand, on occasion, other artemisinins. Artemisinin medications are given to women who are pregnant only if there are no other alternatives and the potential benefit outweighs the potential risks to the fetus. Atovaquone-proguanilis usually well-tolerated, but it occasionally causes an allergic rash or intestinal symptoms. It is given to women who are pregnant or breastfeeding only if there are no other alternatives and the potential benefit outweighs the potential risks to the fetus. Chloroquineis relatively safe for adults, children, and pregnant women when used at the recommended doses. It has a bitter taste and can cause itching and intestinal symptoms, such as abdominal pain, loss of appetite, nausea, and diarrhea. The medication must be kept away from children because overdoses can be fatal.Hydroxychloroquine, a chemically similar medication that has anti-inflammatory activity and is used mainly to treat lupus and rheumatoid arthritis, also has antimalarial activity. Its side effects are similar to those ofchloroquine. Doxycyclinecan cause intestinal symptoms, vaginal yeast infections in women, and sensitivity to sunlight, resulting in a sunburn-like reaction in a small percentage of people. People should take it with a full glass of liquid and should not lie down for several hours to ensure that the medication reaches the stomach. If the medication does not reach the stomach, it can irritate the esophagus and cause severe chest pain. Becausedoxycyclinecan permanently stain the teeth of young children and fetuses, it should not be given to children younger than 8 years old or taken by pregnant women. Mefloquinecauses vivid dreams and insomnia. It can also cause severe psychologic side effects and seizures in people with a seizure disorder (epilepsy), and affect the heart. Thus,mefloquineis avoided in people who are known to have a seizure disorder, psychiatric problem, or heart disorder. People who are taking the medication are given written information about the side effects. Quinineoften causes headache, nausea, vomiting, visual disturbances, and ringing in the ears. This combination of symptoms is called cinchonism.Quininemay also cause a low blood sugar level in people infected withPlasmodium falciparum. Antimalarial medications may harm a fetus. Thus, an expert should be consulted when a pregnant woman is treated. 