The treatment of malaria is crucial in reducing disease severity, preventing complications, and lowering mortality, especially in regions where the disease is endemic.
Fast and accurate treatment cures most malaria cases. However, the right treatment depends on several things. These include the type of Plasmodium, how sick the patient is, whether the patient is pregnant or a child, and local drug resistance.
This section explains first-line medicines, treatment plans for mild and severe cases, how to manage drug resistance, and how to care for high-risk groups. It also covers ways to stop malaria from coming back.
1. Overview of Antimalarial Drugs
Antimalarial medicines attack the parasite at different stages of its life. The most important part of Treatment of Malaria is artemisinin-based combination therapy (ACT). These drugs work together—artemisinin acts fast, and the partner drug clears the rest of the parasites while lowering resistance risk.
Here are common antimalarial drugs:
- Artemether-lumefantrine (Coartem): Used widely for P. falciparum
- Artesunate-amodiaquine
- Artesunate-mefloquine
- Chloroquine: Works for P. vivax, P. ovale, P. malariae, and some P. knowlesi in areas without resistance
- Primaquine: Clears liver-stage parasites in P. vivax and P. ovale
- Quinine: Given in severe cases or where ACT isn’t available
- Atovaquone-proguanil (Malarone): Used for travel and treatment
Doctors choose drugs based on the type of parasite and local drug resistance. The treatment length also depends on these factors.
2. Treatment of Uncomplicated Malaria
Uncomplicated malaria means symptoms are present but without damage to organs or very low blood levels. This is the most common type, especially in early P. falciparum or P. vivax infections.
a. P. falciparum (uncomplicated)
- First choice: ACT like artemether-lumefantrine
- Time: Usually 3 days
- Check-up: If symptoms stay after 48–72 hours, re-evaluate
- In ACT-resistant areas (e.g., Southeast Asia): Doctors may use triple ACTs or other combos
b. P. vivax, P. ovale, P. malariae, P. knowlesi
- Chloroquine still works in many places
- Primaquine stops liver-stage parasites in P. vivax and P. ovale
- Important: Check for G6PD deficiency before giving primaquine to avoid blood problems
Severe and Complex Cases in the Treatment of Malaria
3. Treatment of Severe Malaria
Severe malaria needs urgent hospital care. It shows up with high parasite levels or problems like brain swelling, breathing trouble, kidney failure, or extreme anaemia.
a. First treatment:
- Give intravenous artesunate (better than quinine)
- Dosing: Every 12 hours for the first day, then once daily
- If artesunate isn’t available: Use IV quinine or IM artemether
b. Next steps (oral treatment):
- When the patient can eat and feels better, switch to a full course of ACT
c. Support care:
- IV fluids for hydration
- Blood transfusions for very low red cells
- Fever control with antipyretics
- Seizure control with anticonvulsants
- Oxygen if breathing becomes hard
Fast action greatly lowers the risk of death in severe cases.
4. Drug Resistance Challenges
Drug resistance makes Treatment of Malaria more difficult. Some areas in Asia and Africa now have parasites that fight back against artemisinin and partner drugs. This can slow down recovery or cause treatment to fail.
To handle this, WHO suggests:
- Always use ACTs that work well
- Watch drug resistance trends closely
- Never use artemisinin alone
- Create new medicines and use triple-drug therapies when needed
Fighting drug resistance is key in the global fight to stop malaria.
Tailoring Treatment of Malaria to Specific Groups
5. Treatment in Special Populations
a. Pregnant women
- First trimester: Quinine with clindamycin (ACTs not advised yet)
- Later pregnancy: ACTs are generally safe
- Use IPTp (intermittent preventive therapy) in high-risk areas
b. Children and babies
- Malaria can get worse fast in kids
- ACTs work well and are based on the child’s weight
- IV artesunate is safe and effective for severe cases
c. People with G6PD deficiency
- Avoid drugs like primaquine that can damage red cells
- If cure is needed, doctors may use alternatives or supervised treatment
6. Post-Treatment Considerations
Even after good Treatment of Malaria, some things still need attention.
- Treatment failure: Fever or parasite still present after 3–7 days
- Relapse: Liver-stage forms in P. vivax and P. ovale can reactivate
- Reinfection: Possible in high-risk zones
In places where malaria spreads often, prevention tools matter. These include treated bed nets, indoor spraying, and giving medicine during risk periods.
7. Prevention of Relapse
Some malaria types, like P. vivax and P. ovale, stay hidden in the liver. These forms can cause malaria to return weeks or even months later.
To stop relapse:
- Primaquine: A 14-day pill treatment
- Tafenoquine: A single-dose option, but only with G6PD testing
Stopping relapse is an important step in fully clearing malaria from the body.
Summary
Treatment of Malaria works well if started quickly and matched to the correct parasite and patient. ACTs remain the main choice for P. falciparum. Chloroquine and primaquine are key for P. vivax and P. ovale. Extra care is needed for pregnant women, small children, and those with G6PD deficiency.
Keeping an eye on resistance, making sure treatment works, and stopping future infections all play a role in saving lives and cutting malaria’s impact across the globe.
