From the Guidelines
Malaria diagnosis should be confirmed through laboratory tests, with the most sensitive methods being nucleic acid amplification tests, such as PCR or loop-mediated isothermal amplification (LAMP), which have a sensitivity of 93.9% to 100% and specificity of 93.8% to 100% 1. When it comes to diagnosing malaria, several laboratory tests are available, including:
- Microscopic examination of blood smears
- Rapid diagnostic tests (RDTs)
- PCR testing
- LAMP The choice of test depends on the clinical context and the resources available. Some key points to consider when choosing a diagnostic test for malaria include:
- Sensitivity and specificity of the test
- Availability of the test in the clinical setting
- Cost of the test
- Turnaround time for results
- Ability to detect different species of Plasmodium In terms of treatment, the recommended approach depends on the species of Plasmodium identified and regional resistance patterns. For uncomplicated P. falciparum malaria, artemisinin-based combination therapies (ACTs) are first-line, including artemether-lumefantrine (Coartem) given as 6 doses over 3 days, or dihydroartemisinin-piperaquine 1. It's also important to note that:
- Chloroquine remains effective for P. vivax, P. ovale, P. malariae, and chloroquine-sensitive P. falciparum
- Primaquine should be added to treatment for P. vivax and P. ovale infections to prevent relapse
- Severe malaria requires intravenous artesunate or quinine with close monitoring
- Pregnant women, children, and immunocompromised patients require special consideration for medication selection
- Supportive care, including fluid management, antipyretics, and monitoring for complications, is essential
- Travelers to endemic regions should receive appropriate chemoprophylaxis and use preventive measures like insecticide-treated bed nets and insect repellents.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnostic Tests for Malaria
- Microscopic examination of stained blood smears is the most commonly used and reliable method for diagnosing malaria, as it enables the identification of the species, stage, and density of the infection 2.
- Rapid diagnostic tests (RDTs) are an alternative to microscopy, using a labeled monoclonal antibody to detect circulating parasitic antigens, and are most commonly used to detect Plasmodium falciparum infections 2, 3, 4.
- RDTs are available in a plastic cassette format and can be used in peripheral laboratories with minimally trained staff 2.
- The use of RDTs and artemisinin-based combination therapy (ACT) has been widely advocated by government and the international community as cost-effective tools for diagnosis and treatment of malaria 3, 5.
Treatment of Malaria
- Artemisinin-based combination therapies (ACTs) are the first line treatment for malaria in many countries, including Nigeria 6, 3.
- Triple artemisinin-based combination therapies (TACTs) have been shown to be efficacious, well tolerated, and safe treatments for uncomplicated Plasmodium falciparum malaria, including in areas with artemisinin and ACT partner-drug resistance 6.
- The use of TACTs, such as dihydroartemisinin-piperaquine plus mefloquine and artemether-lumefantrine plus amodiaquine, has been shown to be effective in treating malaria, with high PCR-corrected efficacy rates 6.
- However, the use of ACTs without proper diagnosis can lead to inappropriate case management of malaria, which can increase the economic burden of illnesses 3.
Availability and Use of Diagnostic Tests and Treatment
- The availability and use of RDTs and ACTs vary in public and private health facilities, with public health facilities and health facilities in urban areas using RDTs more 3.
- The main reasons for non-use of RDTs include unreliability, supply issues, costs, preference for other methods of diagnosis, and providers' ignorance 3.
- ACTs are readily available and used in public health facilities, but not always in private health facilities 3.
- The scale-up of malaria rapid diagnostic tests and artemisinin-based combination therapy is challenging in sub-Saharan Africa, with barriers including limited availability of RDTs and ACTs, and inadequate training of healthcare providers 5.