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Malaria N 9 - Subject N 11

A.K. Khare

Malaria is responsible for significant morbidity and mortality in developing countries. Instituting oppropriate therapy without delay is mandatory. Although ideal drug for malaria is yet to come, some general guidelines may be helpful

It is proposed that non-falciparum malaria and chloroquine sensitive falciparum malaria should be treated with chloroquine by mouth or by injection if patient has repeated vomiting.

Chloroquine should not be the drug of choice in areas where falciparum is known to be chloroquine resistant. Chloroquine may not be used to treat non-immune persons, cerebral malaria and acute severe malaria in pregnancy or when malaria has broken out of chloroquine prophylaxis. Quinine dihydrochloride and sulphadoxine-pyrimethamine (Fansidar®) appears to be drug of choice in these situations. Where quinine is unavailable, quinidine may be used as an alternative. If patients are allergic to sulfonamides or antimetabolite resistance is common tetracycline or doxycycline are alternatives to Fansidar®.

Alternatives to quinine include mefloquine, halofantrine and artemisinin and it's derivatives which may be used to treat chloroquine resistant malaria. Common therapeu- tic regimen employing these drugs and their limitations will be discussed.

Efficacy and safety of different treatment modalities will be discussed.

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