From the Guidelines
A 5-year-old boy with malaria who is semiconscious and gasping requires immediate treatment with intravenous artesunate at a dose of 2.4 mg/kg body weight given at 0,12, and 24 hours, then once daily until oral therapy is possible, as recommended by the most recent and highest quality study 1.
Treatment Approach
The treatment approach for this patient should prioritize the management of severe malaria, with a focus on reducing morbidity, mortality, and improving quality of life. The key components of treatment include:
- Intravenous artesunate as the first-line treatment, with a dose of 2.4 mg/kg body weight given at 0,12, and 24 hours, then once daily until oral therapy is possible 1
- If artesunate is unavailable, intravenous quinine can be used at a loading dose of 20 mg/kg followed by 10 mg/kg every 8 hours 1
- Urgent supportive care, including:
- Airway management
- Oxygen therapy
- Correction of hypoglycemia with IV glucose (2-4 ml/kg of 10% dextrose)
- Fluid management to avoid overhydration
- Blood transfusion if hemoglobin is below 5 g/dL
- Seizures should be treated with benzodiazepines (diazepam 0.3 mg/kg IV or rectal) 1
Additional Considerations
In addition to the treatment of severe malaria, the patient may also require empirical antibiotic therapy to cover Gram-positive, Gram-negative, and anaerobic bacteria, as recommended by the study 1. The use of parenteral antibiotics should be considered in children with severe malaria, as they may be at risk of secondary bacterial infections 1.
Outcome Prioritization
The treatment approach should prioritize the reduction of morbidity, mortality, and improvement of quality of life, with a focus on the most recent and highest quality evidence available 1. The use of intravenous artesunate as the first-line treatment is supported by the highest quality evidence, and should be prioritized in the treatment of severe malaria in children.
From the Research
Treatment for Severe Malaria
The treatment for a 5-year-old boy with malaria who is semiconscious and gasping includes:
- Intravenous artesunate (IVA) as the first-line treatment, as recommended by the World Health Organization 2
- A simplified regimen of IVA, which has been shown to be non-inferior to the conventional 5-dose regimen in African children with Plasmodium falciparum malaria 3
- Combination therapy with IVA and intravenous quinine (IVQ), which has been found to be efficacious, safe, and well-tolerated in patients with severe falciparum malaria 4
Important Considerations
- Artesunate has been shown to be more rapidly acting than quinine in terms of parasite clearance, and is safer and simpler to administer 2
- However, there have been reports of haemolytic anaemia associated with artesunate treatment, including oral artemether-lumefantrine 5
- It is essential to monitor patients closely for adverse events and to exclude other causes of anaemia before attributing it to artesunate treatment