From the Guidelines
The treatment for uncomplicated Plasmodium (P.) falciparum malaria is oral artemisinin-based combination therapy (ACT).
Key Treatment Options
- Artemether-lumefantrine (AL): a commonly used ACT for uncomplicated P. falciparum malaria, with a good safety profile and high efficacy 1.
- Dihydroartemisinin (artenimol)-piperaquine: another ACT option, which is also effective and well-tolerated 1.
Important Considerations
- Monitoring: patients with uncomplicated P. falciparum malaria should be monitored for parasitaemia 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 1.
- Post-artemisinin delayed haemolysis (PADH): patients treated with oral ACTs should be monitored for PADH on days 7 and 14 1.
- Resistance: there is increasing concern about the emergence of resistance to ACT regimens in certain regions, and alternative treatments such as atovaquone-proguanil may be considered in these cases 1.
Alternative Treatments
- Atovaquone-proguanil: a second-line treatment option for uncomplicated P. falciparum malaria, which can be used in cases where ACTs are contraindicated or in areas with high levels of resistance to ACTs 1.
- Quinine sulphate: can be used in combination with doxycycline, clindamycin, or mefloquine as an alternative treatment option 1.
From the Research
Treatment Options for Uncomplicated Plasmodium falciparum Malaria
The treatment for uncomplicated Plasmodium falciparum malaria includes several artemisinin-based combination therapies (ACTs). Some of the commonly used treatments are:
- Artemether-lumefantrine: This is the first-line treatment for uncomplicated P. falciparum malaria in some regions 2.
- Pyronaridine-artesunate: This combination has been shown to be efficacious against uncomplicated P. falciparum malaria, with a PCR-adjusted treatment failure rate of less than 5% at days 28 and 42 3.
- Artemisinin-naphthoquine: This combination has been developed in China and is being marketed as a one-day treatment, although the WHO recommends at least three days of the short-acting artemisinin component 4.
- Artesunate-mefloquine: This combination has been shown to be safe and effective for the treatment of uncomplicated P. falciparum malaria, although its efficacy may be reducing in some locations 5.
- Dihydroartemisinin-piperaquine: This combination is an alternative to artemether-lumefantrine for the treatment of uncomplicated P. falciparum malaria 6.
Key Considerations
When treating uncomplicated P. falciparum malaria, it is essential to consider the following:
- The treatment should be started as soon as possible after diagnosis.
- The patient should be monitored closely for signs of severe malaria or treatment failure.
- The treatment regimen should be completed as directed, even if the patient starts to feel better before finishing the course.
- The use of artemisinin-based combination therapies is recommended, as they have been shown to be highly effective against uncomplicated P. falciparum malaria.
Safety and Efficacy
The safety and efficacy of these treatments have been evaluated in several studies:
- Pyronaridine-artesunate has been associated with raised liver enzymes, but no severe drug-induced liver injury has been reported 3.
- Artemether-lumefantrine has been shown to be highly effective, with an adequate clinical and parasitological response of 98.9% and 99.4% with and without PCR correction, respectively 2.
- Artesunate-mefloquine has been shown to be safe and effective, although its efficacy may be reducing in some locations 5.