Treatment

Malaria can be treated successfully.

For falciparum malaria, treating the early uncomplicated stages is far easier than treating it once it has progressed to the severe form of the disease. It is therefore extremely important that patients receive treatment as early as possible.

As soon as malaria is suspected medical help should be sought and a diagnostic test carried out. If the test is positive, treatment should begin immediately. The drugs should be taken exactly as indicated, the right quantities at the right time and with food if this is recommended. The full course should be completed even if the patient starts to feel better.


If the test is negative, medical staff will consider other possible infections or illnesses which may require treatment

While every drug has potential side effects, modern malaria treatments are safe and most are well tolerated.

Drugs used commonly until recently to treat falciparum malaria such as chloroquine, and sulfadoxine-pyrimethamine, face widespread drug resistance problems. Almost all countries worldwide, including all countries in the Asia-Pacific region now recommend artemisinin based combination therapies (ACTs) for treatment of uncomplicated falciparum malaria.

In all but a few areas in the Greater Mekong Sub-region (GMS) artemisinin derivatives are highly effective against all malarias. In ACTs an artemisinin derivative is combined with another drug for better combined effect as well as to try to slow the development and spread of drug resistance, by ensuring parasites not killed by one of the drugs will likely be killed by the other. The drug used in partnership with the artemisinin derivative varies, and is selected based on resistance to the different options in any given area.

ACTs come in tablet form with the two types of drug already combined. Different brands are available and different tablet dosages. Commonly the treatment course will be over several days and it is essential that the course is completed.

Vivax malaria has traditionally been treated with chloroquine partnered with a 14 day course of primaquine. The primaquine is included to clear the dormant liver stages of the vivax parasite (this long course of primaquine is not required for falciparum malaria as it does not develop dormant liver stages). In many places this treatment remains effective for vivax malaria and it is still recommended in some settings. However, in many places vivax malaria is now treated with ACTs, in combination with primaquine. This is the case where vivax has developed resistance to chloroquine, as well as in the many locations worldwide where falciparum and vivax are co-endemic and mixed infections are common.

Primaquine treatment is required to fully clear a vivax infection from the body and avoid relapses of disease. However it is problematic: the 14 day course may well not be adhered to, the drug is not recommended for pregnant women (though can be given after delivery to clear dormant parasites), and the drug is not recommended for individuals with a particular enzyme deficiency - G6PD deficiency – which is common in the Asia-Pacific yet hard to test for. Previously G6PD testing could only be done by a laboratory. More recently rapid tests have become more widely available. These have value to increase accessibility of G6PD testing, though have draw backs, such as cost and inability to measure severity of the condition




ADDITIONAL RESOURCES
on malaria diagnosis, treatment and drug resistance

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