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Treatment of Malaria

Malaria can be a severe, potentially fatal disease (especially when caused by Plasmodium falciparum) and treatment should be initiated as soon as possible. In endemic areas, the World Health Organization recommends that treatment be started within 24 hours after the first symptoms appear. Treatment of patients with uncomplicated malaria can be conducted on an ambulatory basis (without hospitalization) but patients with severe malaria should be hospitalized if possible. In areas where malaria is not endemic, all patients with malaria (uncomplicated or severe) should be kept under clinical observation if possible. Patients who have severe P. falciparum malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion. In some countries (but not the United States) some antimalarial drugs are found in suppository form. Several antimalarial drugs are available for treatment by continuous intravenous infusion. Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease).

They Include: *Quinine, * Chloroquine, * Sulfadoxine-pyrimethamine (Fansidar®), *Mefloquine (Lariam®), *Doxycycline, *Artemisin derivatives (not licensed for use in the United States, but often found overseas).

Quinine Quinine

Quinine comes from the bark of a tree native to South America. According to legend it was first brought to Europe by a Countess who had been treated with it in Peru in the 1600s. The bark was named cinchona in 1742 by Linnaeus. In 1820, two French chemists isolated quinine from the cinchona bark and quinine became a treatment of reference for intermittent fever throughout the world. Quinine remains an important and effective treatment for malaria today, despite sporadic observations of quinine resistance.

Chloroquine Chloroquine

Chloroquine: Research by German scientists to discover a substitute for quinine led to the synthesis in 1934 of Resochin (chloroquine) and Sontochin (3-methyl-chloroquine). These compounds belonged to a new class of antimalarials, the four-amino quinolines. The German research went no further and the formula for Resochin was passed to a US sister company. During World War II, French soldiers happened upon a stash of German-manufactured Sontochin in Tunis and handed it over to the Americans. American researchers made slight adjustments to the captured drug to enhance its efficacy. The new formulation was called chloroquine. Only after comparing chloroquine to the older and supposedly toxic Resochin, did they realize that the two chemical compounds were identical.

Fansidar Fansidar

Fansidar is an antimalarial agent, each tablet containing 500 mg N1-(5,6-dimethoxy-4-pyrimidinyl) sulfanilamide (sulfadoxine) and 25 mg 2,4-diamino-5-(p-chlorophenyl)-6-ethylpyrimidine (pyrimethamine). Each tablet also contains cornstarch, gelatin, lactose, magnesium stearate and talc.It is only used in certain circumstances because resistance to this treatment is high.

Mefloquine Mefloquine

Mefloquine (Lariam) The development of mefloquine was a collaborative achievement of the US Army Medical Research and Development Command, WHO/TDR and Hoffman-La Roche, Inc. Mefloquine’s efficacy in preventing falciparum malaria when taken regularly was shown in 1974 and its potential as a successful treatment agent was shown soon after. Resistance to mefloquine began to appear in Asia in 1985, around the time the drug became generally available.

Doxycycline Doxycycline

Doxycycline is used for the prevention and treatment of malaria. It is particularly suitable for long trips to areas of the world which have become highly chloroquine-resistant. It is considered to be as effective as mefloquine. It is taken daily, starting one to two days before travel and continuing for four weeks after leaving the malarious area. It is used for most adults. People who take doxycycline should be aware that it may make their skin very sensitive to the sun and women may be more prone to thrush.

Artemisinin Artemisinin

Artemisinin was isolated by Chinese scientists in 1972 from Artemisia annua (sweet wormwood), better known to Chinese herbalists for more than 2000 years as Qinghao. In the early 1970s, initial testing by Chinese scientists of Qinghao extracts in mice infected with malaria showed it to be as effective as chloroquine and quinine in clearing the parasite. Mao Tse Tung’s scientists then began testing in humans and in 1979 published their findings in the Chinese Medical Journal. Artemisinin and other artemether-group drugs are currently the main line of defense against drug resistant malaria in many parts of South-East Asia. To date there have been no reported cases of resistant to artemisinin. Artemisinin is today a very potent and effective antimalarial drug, especially when used in combination with other malaria medicines.

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.

Primaquine Primaquine

Primaquine is an antimalarial drug. The exact way that primaquine works is unknown. Primaquine is used to treat and prevent malaria.

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.

However, if you have had a serious side effect while taking a drug, you or your health care provider can report that side effect to the federal Food and Drug Administration (FDA). MedWatch is the FDA Safety Information and Adverse Event Reporting Program. You are encouraged to take the reporting form to your health care provider. Alternatively, health care providers can report to the FDA.

The advantage to having your health care provider file the report is that he/she can provide clinical information based on your medical record that can help the FDA evaluate the report. However, for a variety of reasons, you may not wish to have the form completed by your provider, or the provider may not wish to complete the form. Your health care provider is not required to report to the FDA. In this case, you may complete the online reporting form at * yourself via the Internet.


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