From the Guidelines
Corticosteroids are not recommended for the treatment of cerebral malaria. The most recent and highest quality evidence suggests that corticosteroids do not improve outcomes and may actually increase complications in patients with cerebral malaria 1. The standard treatment for cerebral malaria remains intravenous artesunate or intravenous quinine if artesunate is unavailable. Supportive care is crucial, including management of seizures, hypoglycemia, fluid balance, and respiratory support.
Some key points to consider in the management of cerebral malaria include:
- Rapid administration of effective antimalarial therapy
- Appropriate supportive care, including management of seizures, hypoglycemia, fluid balance, and respiratory support
- Avoidance of corticosteroids due to their potential to worsen outcomes 1
- Consideration of other treatments, such as mannitol, to manage raised intracranial pressure, although their effectiveness in cerebral malaria is not well established 1
The pathophysiology of cerebral malaria involves sequestration of parasitized red blood cells in cerebral microvasculature and inflammatory responses, but corticosteroids' anti-inflammatory effects do not translate to clinical benefit in this condition. Instead, they may increase the risk of gastrointestinal bleeding, secondary infections, and potentially worsen outcomes. Focus should remain on rapid administration of effective antimalarial therapy and appropriate supportive care.
From the Research
Corticosteroids in Cerebral Malaria
- The use of corticosteroids in the management of cerebral malaria has been studied, and the evidence suggests that they have no place in the treatment of this condition 2, 3.
- A randomized, placebo-controlled trial of dexamethasone in cerebral malaria yielded results that led to the abandonment of ancillary corticosteroid therapy in this disease 3.
- The pathophysiology of cerebral malaria is complex and involves infected erythrocyte sequestration, cerebral inflammation, and breakdown of the blood-brain barrier, but corticosteroids do not appear to be effective in modifying this process 4, 5.
- Treatment of cerebral malaria consists of supportive care and antimalarial administration, with no evidence to support the use of adjuvant therapies such as corticosteroids 4, 6.
- The focus of current research is on developing effective malaria prevention and interventional strategies to avert high mortality and morbidity associated with cerebral malaria, rather than exploring the use of corticosteroids 2, 5.