Antimalarial Chemotherapy

Abstract

This chapter covers the clinical use of antimalarial drugs for severe and uncomplicated falciparum malaria, and for malaria due to P. vivax, ovale and malariae. Parenteral quinine is the drug of first choice for severe falciparum malaria. If given intravenously, quinine must be diluted and given by slow infusion; quinine may also be given intramuscularly. In parts of South East Asia, where sensitivity to quinine is declining, intramuscular artemether (or other artemisinin-derivatives) may become the drug of first-choice in the near future. Uncomplicated falciparum malaria is most commonly treated with oral chloroquine but, because of widespread resistance, alternatives should be used if available. Plasmodium falciparum usually retains sensitivity to pyrimethamine/sulphadoxine (Fansidar®) in Africa, but is usually resistant in South East Asia, where quinine, mefloquine or halofantrine are usually required. Plasmodium ovale and malariae, and most P. vivax are sensitive to chloroquine. To prevent recurrence (from dormant liver stages) patients with P. vivax or ovale infections are given primaquine, after checking their glucose-6-phosphate dehydrogenase status.