infectious diseases
Malaria
Treatment of Malaria
Antimalarial drugs Antimalarial drugs are chosen based on the following: Disease severity (clinical and laboratory criteria) InfectingPlasmodiumspecies Known resistance patterns of strains in the area of acquisition Efficacy and adverse effects of drugs available Artemisinin-based combination therapy, such as oralartemether/lumefantrine, is the most rapidly active treatment, and in many situations, it is the treatment of choice. Resistance to artemisinins has been reported but is not yet common. Severity of malaria requires urgent treatment, preferably with intravenous Due to the risk of progression to severe disease in patients withP. falciparuminfection, patients should be hospitalized to monitor clinical response and to check parasite density every 12 to 24 hours until clinical presentation improves and a decrease in parasite density becomes apparent (seeCDC: Treatment of Malaria: Guidelines for Clinicians [United States]). ( Treatment references ), hemoglobin levels should be monitored for 4 weeks after therapy. Time is of the essence in treating severe malaria. Begin treatment with IVartesunateas soon as possible. Start interim oral therapy with other drugs if IVartesunateis not immediately available. In some endemic areas, a significant proportion of locally available antimalarial drugs are counterfeit. Thus, some clinicians advise travelers to remote, high-risk areas to take along a full course of an appropriate treatment regimen to be used if medically confirmed malaria is acquired despite prophylaxis; this strategy also avoids depleting limited drug resources in the destination country. Malaria is particularly dangerous in children<5 years (mortality is highest in those<2 years), pregnant women, and previously unexposed visitors to endemic areas. is common in Papua New Guinea, Indonesia, and emerging in some other areas (eg, Southeast Asia, South Asia, the Middle East, East Africa, and the Americas) ( Treatment references ). For recommended drugs and doses for treatment and prevention of malaria, see tablesand. Common adverse effects and contraindications are listed in table. See also the CDC web site (Malaria Diagnosis and Treatment in the United States), or for emergency consultation about management, call the CDC Malaria Hotline at the numbers listed above. In case of a febrile illness during travel in an endemic region, prompt professional medical evaluation is essential. When prompt evaluation is not possible (eg, because the region is very remote), self-medication withartemether/lumefantrineoratovaquone/proguanilcan be considered pending evaluation. If travelers present with fever after returning from an endemic region and no other diagnosis is made, clinicians should consider giving empiric treatment for uncomplicated malaria even when malaria smears and/or rapid diagnostic tests are negative. 1.Aldámiz-Echevarría LT, López-Polín A, Norman FF, et al: Delayed haemolysis secondary to treatment of severe malaria with intravenousartesunate: Report on the experience of a referral centre for tropical infections in Spain.Travel Med Infect Dis15:52-56, 2017. doi:10.1016/j.tmaid.2016.10.013 2.Ferreira MU, Nobrega de Sousa T, Rangel GW, et al: MonitoringPlasmodium vivaxresistance to antimalarials: persisting challenges and future directions.Int J Parasitol Drug-Drug Resist15:9-24, 2021. doi:10.1016/j.ijpddr.2020.12.001 