From the Guidelines
The treatment for malaria should prioritize artemisinin-based combination therapies (ACTs) such as dihydroartemisinin-piperaquine or artemether-lumefantrine for uncomplicated Plasmodium falciparum malaria, and intravenous artesunate for severe cases, as recommended by the most recent guidelines 1, 2, 3.
Treatment Options
- For uncomplicated P. falciparum malaria, the first-line treatment options include: + Dihydroartemisinin-piperaquine (320 mg/40 mg) for 3 days, with dosing based on weight (36 to 75 kg: 3 tablets per day, >75 kg: 4 tablets per day) 1 + Artemether-lumefantrine (20 mg + 120 mg) for 3 days, with specific dosing based on weight (>35 kg: 4 tablets at 0, 8, 24, 36, 48, and 60 hours) 1
- For severe P. falciparum malaria, intravenous artesunate is the recommended first-line treatment, followed by oral therapy with an ACT when the patient can tolerate it 3 ### Monitoring and Supportive Care
- For complicated malaria, continuous monitoring of cardiocirculatory, pulmonary, kidney, and metabolic parameters is essential, as well as monitoring of peripheral blood parasitaemia every 12 hours until a decline to <1% is observed 4
- For uncomplicated falciparum malaria, monitoring of parasitaemia should be done at least on day 3 and day 7, with an expected target reduction of 75% of the initial value on day 3 and a negative result on day 7 4 ### Considerations
- The choice of medication depends on drug resistance patterns in the area where the infection was acquired, the patient's age, pregnancy status, and other medical conditions 1, 2, 3
- Treatment should begin immediately after diagnosis, as delayed treatment can lead to complications or death, especially with P. falciparum infections 1, 2, 3
From the FDA Drug Label
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 treatment for malaria is Atovaquone and proguanil hydrochloride. The recommended dose for adults is:
From the Research
Treatment Options for Malaria
- The treatment of uncomplicated malaria acquired in areas of chloroquine resistance is based on oral drugs chosen according to local resistance patterns 7.
- Artemisinin-based combination therapies (ACTs) are the first-line treatment of Plasmodium falciparum malaria, with artemether-lumefantrine (AL) being one of the combinations used 8, 9.
- AL is effective in case of resistance to other antimalarials and is an alternative to the atovaquone + proguanil combination for travelers 7.
- The efficacy of AL has been shown to be fairly consistent and similar to that of other combinations, such as amodiaquine + sulfadoxine + pyrimethamine, in African trials 7.
- However, there have been reports of treatment failures with AL, particularly in nonimmune adults, highlighting the need for optimal dosing and patient monitoring 8.
Administration and Safety
- The absorption of lumefantrine, a component of AL, is dependent on the presence of food in the stomach, and intake of about 1.5 g of fat seems sufficient for satisfactory absorption 7.
- AL has been shown to be safe and well-tolerated, with the majority of reported 28-day PCR-corrected cure rates being above 95% in sub-Saharan Africa 9.
- However, artemisinin derivatives, including AL, should not be used in the first trimester of pregnancy unless there are no effective alternatives due to uncertainty over their safety 10.
- The adverse effect profiles of artemisinin-based combination treatments are determined by the partner drug, with occasional hypersensitivity reactions being a concern 10.