From the Guidelines
The antimalarial combination drug that starts with C is Chloroquine (CQ) or more specifically, a combination such as DHAePPQ (dihydroartemisinin-piperaquine), which is preferred due to its longer half-life, as stated in the study published in Clinical Microbiology and Infection in 2024 1.
Key Points:
- Chloroquine is used for the treatment of uncomplicated malaria caused by P. vivax or P. ovale, with a regimen of 4 tablets (1000 mg salt) then 2 tablets (500 mg salt) at 6,24, and 48 hours.
- DHAePPQ is an alternative treatment for uncomplicated malaria and is preferred due to its longer half-life.
- The choice of antimalarial drug depends on the species of Plasmodium, the severity of the disease, and the presence of resistance in the area where the infection was acquired.
- It is essential to consider the potential side effects and contraindications of each drug, such as nausea, vomiting, and pruritus with Chloroquine, and to test for G6PD deficiency before administering primaquine or tafenoquine.
Treatment Regimens:
- For P. vivax or P. ovale, the first-line treatment is Chloroquine, with an alternative treatment being DHAePPQ or AL (artemether-lumefantrine).
- For P. falciparum, the first-line treatment is an artemisinin-based combination therapy (ACT), such as DHAePPQ or AL.
- For complicated malaria, the preferred treatment is intravenous artesunate, with quinine dihydrochloride as an alternative.
Important Considerations:
- The treatment of malaria should be guided by the most recent and highest-quality evidence, taking into account the specific circumstances of each patient.
- The potential for resistance to antimalarial drugs, such as artemisinin resistance in Africa, should be considered when selecting a treatment regimen.
- The use of antimalarial drugs in pregnancy and lactation should be carefully evaluated, with AL now endorsed for use in any trimester of pregnancy by WHO and CDC 1.
From the Research
Antimalarial Combination Drugs
- The antimalarial combination drug that starts with C is Coartem, which is a fixed-dose combination of artemether and lumefantrine 2, 3, 4, 5, 6.
Characteristics of Coartem
- Coartem is indicated for the treatment of infants, children, and adults with acute, uncomplicated infection due to Plasmodium falciparum or mixed infections including P. falciparum 2.
- The efficacy of the six-dose regimen of artemether/lumefantrine has been confirmed in many different patient populations around the world, consistently achieving 28-day PCR-corrected cure rates of >95% in the evaluable population 2.
- Coartem has a synergistic anti-malarial activity due to its two components having different modes of action 2.
Comparison with Other Antimalarial Drugs
- Coartem is an alternative to the atovaquone + proguanil combination for travelers 3.
- Coartem is more effective than the quinine + doxycycline combination in a region of Brazil where strains with diminished sensitivity to quinine circulate 3.
- Coartem is effective in case of resistance to other antimalarials 3, 5.