From the Guidelines
For a patient with a history of malaria who is currently diagnosed with non-falciparum malaria and has already received Artemisinin-based Combination Therapy (ACT), the recommended treatment is chloroquine, administered as a total dose of 25 mg base/kg over three days, as supported by the most recent evidence 1. The typical adult regimen is 600 mg base (1000 mg salt) orally as an initial dose, followed by 300 mg base (500 mg salt) orally at 6,24, and 48 hours after the first dose.
- Key considerations for treatment include:
- The use of chloroquine for non-falciparum malaria, including P. vivax, P. ovale, and P. malariae, due to its efficacy against these species 1.
- The administration of primaquine or tafenoquine for patients with P. vivax or P. ovale to eliminate hypnozoites and prevent relapse, with the necessity of confirming normal G6PD status beforehand to avoid hemolysis in G6PD-deficient individuals 1.
- Supportive care, including antipyretics, adequate hydration, and monitoring for complications, to ensure comprehensive management of the patient. This approach is based on the most recent and highest quality evidence available, prioritizing the patient's morbidity, mortality, and quality of life outcomes.
From the Research
Treatment of Non-Falciparum Malaria
Given the patient's history of malaria and current diagnosis of non-falciparum malaria, with Artemisinin-based Combination Therapy (ACT) already administered, the following points are relevant:
- ACT is effective against non-falciparum malaria, including Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae 2.
- For non-falciparum malaria, ACT is as effective as chloroquine in preventing recurrent parasitaemia before day 28, and artemisinin-based combinations with long half-lives show significantly fewer recurrent parasitaemia up to day 63 2.
- The limited evidence available supports both the use of chloroquine and an ACT for P. ovale and P. malariae 2.
- ACT seems to be preferable for optimal treatment of P. knowlesi 2.
- For uncomplicated malaria due to chloroquine-sensitive parasites, treatment with either artemisinin-based combination therapy or chloroquine is recommended 3.
Considerations for Treatment
Key considerations for the treatment of non-falciparum malaria include:
- The species of Plasmodium causing the infection
- The drug sensitivity of the parasites from the region of acquisition
- The use of ACT as a first-line treatment for uncomplicated P. falciparum malaria, and its effectiveness against non-falciparum species
- The need for additional therapy with an 8-aminoquinoline to eradicate the liver stage in cases of P. vivax and P. ovale 3
Efficacy of ACT
Studies have shown that ACT is highly efficacious in treating uncomplicated falciparum malaria, with PCR-corrected adequate clinical and parasite response rates (ACPRcs) of over 98% in some regions 4.