From the Guidelines
The most effective treatment for malaria is artemisinin-based combination therapies (ACTs), with artemether-lumefantrine being a common first-line treatment for uncomplicated Plasmodium falciparum malaria, and chloroquine plus primaquine for P. vivax malaria, as recommended by the WHO and supported by recent studies 1.
Treatment Regimens
- For uncomplicated P. falciparum malaria, a typical regimen includes artemether-lumefantrine taken twice daily for 3 days, with specific dosing based on weight.
- For P. vivax malaria, chloroquine (typically 600mg base, followed by 300mg at 6,24, and 48 hours) plus primaquine (usually 30mg daily for 14 days) is often used.
- Severe malaria requires injectable artesunate (2.4mg/kg) given intravenously or intramuscularly at 0,12,24 hours, then daily until oral medication can be tolerated.
Important Considerations
- Treatment should begin immediately after diagnosis, as confirmed by blood tests like microscopy or rapid diagnostic tests.
- Patients should complete the full course of medication even if symptoms improve, stay hydrated, rest, and monitor for fever.
- Antimalarials work by interfering with the parasite's ability to digest hemoglobin or by disrupting other metabolic processes essential for parasite survival.
- Treatment choice depends on the infecting Plasmodium species, local resistance patterns, patient factors, and severity of illness.
Recent Guidelines and Recommendations
- The WHO recommends intravenous artesunate as a first-line treatment for all forms of severe malaria 1.
- The use of ACTs, such as artemether-lumefantrine, is endorsed by the WHO and CDC for uncomplicated malaria in all trimesters of pregnancy 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Malaria Treatment in Adults Treatment of mild to moderate malaria in adults caused by mefloquine-susceptible strains of P. falciparum or by P. vivax: Dosage: Five tablets (1250 mg) mefloquine hydrochloride USP to be given as a single oral dose. Treatment of Acute Malaria: Adults: Four Atovaquone and proguanil hydrochloride tablets (adult strength; total daily dose 1 g atovaquone/400 mg proguanil hydrochloride) as a single dose daily for 3 consecutive days
The most common treatment for malaria is mefloquine or atovaquone and proguanil hydrochloride.
- For mefloquine, the dosage is five tablets (1250 mg) given as a single oral dose.
- For atovaquone and proguanil hydrochloride, the dosage is four tablets (1 g atovaquone/400 mg proguanil hydrochloride) given daily for 3 consecutive days 2 3.
From the Research
Malaria Treatment
The most common treatment for malaria is artemisinin-based combination therapies (ACTs) 4. ACTs combine the rapid schizontocidal activity of an artemisinin derivative with a longer-half-life partner drug.
Types of ACTs
Some of the available ACTs include:
- Artesunate-mefloquine: highly effective but expensive and can have side effects such as neurotoxicity 4
- Artemether-lumefantrine: less effective than artesunate-mefloquine and requires administration with food to ensure adequate bioavailability 4
- Dihydroartemisinin-piperaquine: highly effective, well tolerated, and relatively inexpensive 4, 5
- Artemether-lumefantrine plus amodiaquine: provides an alternative to artemether-lumefantrine alone as first-line treatment for multidrug-resistant P. falciparum malaria 6
Efficacy of ACTs
The efficacy of ACTs has been studied in various trials:
- A trial in India found that the PCR-corrected therapeutic efficacies of AS-SP, AM-LF, and AS-MQ were 90.6%, 95.9%, and 100%, respectively 7
- A trial in Mali found that artemether-lumefantrine with or without primaquine was effective in reducing gametocyte carriage and transmission to mosquitoes 8
- A trial in Cambodia, Vietnam, and other locations found that artemether-lumefantrine plus amodiaquine was effective in treating multidrug-resistant P. falciparum malaria 6
Administration of ACTs
ACTs are typically administered orally, with the exact dosage and duration of treatment depending on the specific combination and the patient's condition: