Once malaria diagnosed, treatment decision depends on:
- The species of the infecting parasite (if known, otherwise treated as falciparum malaria)
- The geographic area ant its drug- resistance status
- The age of the patient
- The severity of the disease and the clinical status of the patient
- The possibility of pregnancy
- Drug allergies
Species: it is important to know which malaria species to fight for many reasons; firstly, P. falciparum and P. knowlesi can cause rapidly severe disease in comparison to mild illness in case of P. vivax, P.ovale and P. malariae. Secondly, P. vivax and P. ovale infections require additional treatment for the hypnozoites that stay dormant in the liver and may cause relapses in the future and finally, P. vivax and P. falciparum have different drug resistance status according to the area.
Geographic area: knowing the area the infection was acquired, we can be informed about the specific drug – resistance status and thus choose the appropriate drug(s).
Age: special attention should be given to extreme ages; children under the age of 5 (different side effects and drug tolerance) and elders (accompanying illness).
Severity/ clinical status: different approach of an uncomplicated malaria contrary to a severe malaria infection where aggressive treatment and adjunctive measures should be provided.
Pregnancy: pregnant women are three times more vulnerable to developing severe disease than non- pregnant women. Also, there are medications not recommended to be taken during pregnancy- fact that reduces the treatment choices.
: as with all medicines, it should be given special attention.
The following links show the Guidelines for the pharmaceutical treatment of malaria according to the American Center for Disease Control and Prevention and the Hellenic Center for Disease Control and Prevention respectively.
CDC - Guidelines for malaria treatment
HCDCP - Guidelines for malaria treatment
Additional treatment interventions for the management of severe malaria
|patient’s airway should be protected (intubation if that is necessary)
|simple antipyretic drugs (paracetamol in order to avoid extra renal charge)
and cooling blankets
|Dehydration, electrolyte imbalance, hypoclycemia
|monitoring and correction
|Intravenous or rectal form of diazepam
|Spontaneous bleeding and coagulation
|fresh frozen plasma and vitamin K
|fluids provision should be interrupted while diuretics and respiratory support should be our priorities
|Acute renal failure