From the Guidelines
The treatment for falciparum malaria requires prompt administration of effective antimalarial medications, with artemisinin-based combination therapies (ACTs) being the first-line treatment for uncomplicated cases, and intravenous artesunate being the preferred treatment for severe cases. For uncomplicated Plasmodium falciparum malaria, the recommended ACTs include artemether-lumefantrine, artesunate-amodiaquine, dihydroartemisinin-piperaquine, or artesunate-mefloquine 1. A typical regimen of artemether-lumefantrine involves six doses over three days, while dihydroartemisinin-piperaquine is given as 3 tablets per day for 3 days for patients weighing 36-75 kg, and 4 tablets per day for 3 days for patients weighing more than 75 kg 1. For severe falciparum malaria, intravenous artesunate is recommended at 2.4 mg/kg at 0,12, and 24 hours, then daily until oral therapy can be tolerated, with a switch to a full course of an oral ACT once the patient is clinically improved and able to take oral treatment 1. Alternative treatments include intravenous quinine or quinidine if artesunate is unavailable, with quinine sulphate plus doxycycline or clindamycin being used as alternative treatments in some cases 1. Patients should be monitored for complications such as cerebral malaria, severe anemia, respiratory distress, and renal failure, and supportive care including fluid management, antipyretics, and management of complications is essential alongside antimalarial therapy 1. It is also important to note that the treatment of falciparum malaria should be individualized based on the patient's specific needs and circumstances, and that the use of ACTs has been endorsed by the WHO and CDC for the treatment of uncomplicated malaria in all trimesters of pregnancy 1. Additionally, the risk of post-artemisinin delayed haemolysis (PADH) should be considered when using ACTs, particularly in patients with severe malaria 1. Overall, the key to effective treatment of falciparum malaria is prompt administration of effective antimalarial medications, along with supportive care and monitoring for complications.
Some key points to consider when treating falciparum malaria include:
- The use of ACTs as the first-line treatment for uncomplicated cases
- The use of intravenous artesunate as the preferred treatment for severe cases
- The importance of monitoring for complications and providing supportive care
- The need to individualize treatment based on the patient's specific needs and circumstances
- The risk of PADH when using ACTs, particularly in patients with severe malaria.
It is also important to note that the treatment of falciparum malaria should be guided by the most recent and highest quality evidence, and that the use of outdated or ineffective treatments should be avoided 1. In terms of specific medications and dosing regimens, the following are recommended:
- Artemether-lumefantrine: 6 doses over 3 days
- Dihydroartemisinin-piperaquine: 3 tablets per day for 3 days for patients weighing 36-75 kg, and 4 tablets per day for 3 days for patients weighing more than 75 kg
- Intravenous artesunate: 2.4 mg/kg at 0,12, and 24 hours, then daily until oral therapy can be tolerated
- Quinine sulphate plus doxycycline or clindamycin: used as alternative treatments in some cases.
Overall, the treatment of falciparum malaria requires a comprehensive approach that includes the use of effective antimalarial medications, supportive care, and monitoring for complications.
From the FDA Drug Label
1 INDICATIONS AND USAGE Quinine sulfate capsules are an antimalarial drug indicated only for treatment of uncomplicated Plasmodium falciparum malaria. Quinine sulfate has been shown to be effective in geographical regions where resistance to chloroquine has been documented [ see Clinical Studies (14)]
- 1 Treatment of Uncomplicated P. falciparum Malaria For treatment of uncomplicated P. falciparum malaria in adults: Orally, 648 mg (two capsules) every 8 hours for 7 days [ see Clinical Studies (14)]. Quinine sulfate capsules should be taken with food to minimize gastric upset [ see Clinical Pharmacology (12.3)].
The treatment for uncomplicated Plasmodium falciparum malaria is quinine sulfate capsules. The recommended dosage for adults is 648 mg (two capsules) every 8 hours for 7 days.
- Key points:
- Quinine sulfate capsules should be taken with food to minimize gastric upset.
- The dosage regimen may need to be adjusted in patients with severe chronic renal impairment.
- Quinine sulfate capsules are not approved for treatment of severe or complicated P. falciparum malaria.
- Quinine sulfate capsules are not approved for prevention of malaria 2
From the Research
Treatment for Falciparum Malaria
The treatment for falciparum malaria typically involves the use of artemisinin-based combination therapies (ACTs) as recommended by the World Health Organization 3, 4, 5.
- Artemether-lumefantrine (AL): This is the most widely adopted first-line ACT for uncomplicated malaria in sub-Saharan Africa, including mainland Tanzania 3. AL has been shown to have adequate efficacy and safety for the treatment of uncomplicated falciparum malaria, with PCR-corrected adequate clinical and parasitological response (ACPR) rates ranging from 97.6% to 100% 3.
- Artesunate-mefloquine: This combination is also effective and safe for the treatment of uncomplicated falciparum malaria, with PCR-corrected ACPR rates of 90.9% 6.
- Dihydroartemisinin-piperaquine: This combination is highly effective, well tolerated, and relatively inexpensive, making it a potential option for the treatment of falciparum malaria 5.
- Triple Artemisinin-Based Combination Therapies: These therapies, such as dihydroartemisinin-piperaquine-mefloquine, have been investigated as a potential strategy to retard and reverse the spread of resistant parasites 7.
Efficacy and Safety
The efficacy and safety of these treatments have been evaluated in various studies, with results showing that they are effective and well tolerated in patients with uncomplicated falciparum malaria 3, 4, 6, 5.