Treatments

Treatment of Malaria depends on the following factors:

• Type of infection : the infecting species of Plasmodium parasite
• Severity of infection
• Status of the host : the clinical situation of the patient (for example, adult, child, or pregnant female with either mild or severe malaria)
• Associated conditions or diseases : the drug susceptibility of the infecting parasites

     When properly treated, a patient with malaria can expect a complete recovery. The treatment of malaria depends on the severity of the disease; whether patients who can take oral drugs have to be admitted depends on the assessment and the experience of the clinician.

         Mild malaria can be treated with oral medication. The most effective strategy for P. falciparum infection recommended by World Health Organisation is the use of artemisinins in combination with other antimalarials artemisinin-combination therapy, ACT, in order to avoid the development of drug resistance against artemisinin-based therapies.

             Severe malaria requires intravenous (IV) drug treatment and fluids in the hospital. It requires the parenteral administration of antimalarial drugs. Until recently the most used treatment for severe malaria was quinine but artesunate has been shown to be superior to quinine in both children and adults.  Treatment of severe malaria also involves supportive measures.

Treatments of malaria Includes:

• Anti-malarial drugs can be prescribed to people traveling to areas where malaria is prevalent. Malaria can be treated with drugs. However, treatment is complicated because each type of malaria requires a different drug.
• Quinine is an effective in treating some forms of malaria, but other parasites have developed a resistance to quinine.
• If quinine is not effective, then a modified form of quinine known as chloroquine can also be used.

New drug treatments of malaria are currently under study because Plasmodium species continue to produce resistant strains that frequently spread to other areas. One promising drug class under investigation is the spiroindolones, which have been effective in stopping P. falciparum experimental infections.

Drugs Used in the Treatment of Malaria

Quinine

A naturally occurring alkaloid derived from the bark of Cinchona spp.

• Mechanism of Action -- Quinine is effective against all four spp. of Plasmodium. Its exact mechanism is unknown.  It does decrease DNA strand separation and transcription, thereby inhibiting protozoal protein synthesis.  This is presumed to be the effective mechanism of action.  Resistance may develop to the effects of quinine.
• Adverse Effects -- GI disturbances (may be severe), hæmolysis, cardiac effects (quinidine-like effects, but less pronounced), hypoglycæmia (directly causes insulin release).
• Toxicity -- Cinchonism -- Headache, nausea, visual disturbances, dizziness, tinnitus
• Contraindications -- Pre-existing hæmolysis, hypersensitivity, pregnancy (quinine may also directly stimulate uterine contractions), arrhythmias. 

Quinidine

A stereoisomer of quinine, this agent is used primarily as an intravenous version of quinine (parenteral quinine is not available in the U.S.A.).  The mechanisms and side effects have been discussed previously (above and in the anti-arrhythmic section).

Chloroquine and Hydroxychloroquine

• Mechanism of Action -- These agents are probably acting in a manner similar to quinine.  They may also increase the pH of the erythrocyte and decrease phospholipid metabolism of the protozoa, both of which could contribute to their efficacy.  Resistance may develop to chloroquine and hydroxychloroquine.
• Adverse Effects -- Typically, less severe than quinine -- Headache, GI, pruritus.
• Uses -- Chloroquine may be used for acute treatment or prophylaxis of malaria, amebiasis, and auto-immune diseases.