Malaria: Treatment
Stage specificity of antimalarial drugs
1. Pre-erythrocytic schizogony
- Merozoites are liberated into blood.
- Drugs acting on this stage will prevent infection of RBC and clinical attack of malaria causal prophylaxis.
- Drug are
- Proguanil & Tetracycline → for falciparum.
2. Primaquine for all species
- Erythrocytic schizogony
- Drugs acting on this phase will cause clinical cure.
Fast acting →
- Chloroquine, amadioquine, quinine, mefloquine, halofantrine, lumefanterine, atovaquone, artimisinin.
Slow acting →
- Pyrimethamine, proguanil, sulfonamides, tetracyclines.
3. Gametogony
- Gametocidal drugs are used to reduce transmission. T
- These drugs are of no benefit to the patient being treated.
- Drugs are
- Primaquine & artimisinins → for all species
- Chloroquine & quinine → for P.vivax
4. Exoerythrocytic schizogony
- Drugs acting in this stage prevent relapse and are used for radical cure.
- Primaquine is the only drug which acts on exoerythrocytic schizogony.
Treatment of falciparum malaria
- Artemisinin derivatives are the drug of choice for any type of falciparum malaria
- Uncomplicated
- Complicated/severe/cerebral
- Amongst artemisinin derivatives, artesunate is the DOC.
- Other drugs used for severe/complicated/cerebral falciparum malaria: Artemether , Quinine , Quinidine.
Chemoprophylaxis of malaria
- Chemoprophylaxis is recommended for travellers from non-endemic areas, and as a short-term measure for soldiers, police and labour forces serving in highly endemic areas.
Chemoprophylaxis should begin:
- Week before arrival in the malarious area
- Continued for at least 4 weeks or preferably 6 weeks after leaving malarious area.
Drugs used are :
Chloroquine
- DOC for chemoprophylaxis in chloroquine sensitive P. falciparum areas.
- Chloroquine 300 to 310 mg once weekly, and Proguanil 200 mg once daily
Atovaquone/Proguanil
- Used in areas with chloroquine or mefloquine-resistant P. falciparum.
Doxycycline
- Used in areas with chloroquine or mefloquine-resistant P. falciparum.
Mefloquine
- Used in areas with chloroquine-resistant P. falciparum
Hydroxychloroquine
- Alternative to chloroquine in areas with chloroquine-sensitive P. falciparum
Drugs for chloroquine resistant malaria
- Sulfadoxine +Pyrimethamine + Artesunate(DOC)
- Artemether + Lumefantrine
- Quinine + Tetracycline or doxycycline +Primaquine
- Halofantrine
- Mefloquine + Artesunate
Treatment of resistant falciparum malaria in children
i. Child < 8 years of age
- Quinine + Clindamycin
- Or Atovaquone + Proguanil
ii. Child > 8 years of age
- Quinine + Doxycycline / Tetracycline
- Or Atovaquone + Proguanil
Treatment in pregnant women
- If plasmodium is sensitive to chloroquine →chloroquine is the DOC.
- For chloroquine resistant strains →Quinine
- Pyrimethamine plus dapsone should not be given in first trimester but may be given in 2nd & 3rd trimester for chloroquine resistant malaria.
- Mefloquine is teratogenic and a woman should avoid pregnancy whilst taking it, and for 3 months after. o For prophylaxis in P.fakifarum endemic are
- Choloroquine sensitive malaria —> chloroquine is the DOC.
- Proguanil (with folic acid) may also be used.
Exam Question
Stage specificity of antimalarial drugs
1. Pre-erythrocytic schizogony
- Drugs acting on this stage will prevent infection of RBC and clinical attack of malaria causal prophylaxis.
- Drug are
- Proguanil & Tetracycline → for falciparum.
2. Primaquine for all species
- Slow acting are →
- Pyrimethamine, proguanil, sulfonamides, tetracyclines.
3. Gametogony
- Primaquine & artemisinins → for all species
- Chloroquine & quinine → for P.vivax
4. Exoerythrocytic schizogony
- Primaquine is the only drug which acts on exoerythrocytic schizogony.
Treatment of falciparum malaria
- Artemisinin derivatives are the drug of choice for any type of falciparum malaria
- Uncomplicated
- Complicated/severe/cerebral
- Amongst artemisinin derivatives, artesunate is the DOC.
- Other drugs used for severe/complicated/cerebral falciparum malaria: Artemether , Quinine , Quinidine.
Chemoprophylaxis of malaria
Chloroquine
- DOC for chemoprophylaxis in chloroquine sensitive P. falciparum areas.
- Chloroquine 300 to 310 mg once weekly, and Proguanil 200 mg once daily
Atovaquone/Proguanil
- Used in areas with chloroquine or mefloquine-resistant P. falciparum.
Doxycycline
- Used in areas with chloroquine or mefloquine-resistant P. falciparum.
Mefloquine
- Used in areas with chloroquine-resistant P. falciparum
Hydroxychloroquine
- Alternative to chloroquine in areas with chloroquine-sensitive P. falciparum
Drugs for chloroquine resistant malaria
- Sulfadoxine +Pyrimethamine + Artesunate(DOC)
- Artemether + Lumefantrine
- Quinine + Tetracycline or doxycycline +Primaquine
- Halofantrine
- Mefloquine + Artesunate
Treatment of resistant falciparum malaria in children
- Child < 8 years of age
- Quinine + Clindamycin
- Or Atovaquone + Proguanil
Treatment in pregnant women
- If plasmodium is sensitive to chloroquine → chloroquine is the DOC.
- For chloroquine resistant strains → Quinine
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