Malaria is an infectious disease caused by Plasmodium parasites residing in red blood cells. The treatment goal is to eradicate the parasites, alleviate symptoms, and prevent complications. It primarily relies on antimalarial medications, with treatment plans tailored according to the species of Plasmodium (such as Plasmodium falciparum, Plasmodium vivax) and patient factors such as age and pregnancy status. Timely treatment can significantly reduce mortality, especially in cases of Plasmodium falciparum infection, which requires emergency management.
Treatment is divided into two main categories: "Antimalarial Drugs" and "Supportive Therapy." Antimalarial drugs mainly work by inhibiting parasite replication within red blood cells or disrupting their metabolism. For example, artemisinin derivatives induce free radicals that damage the parasite's cell membrane. Combination therapies (such as ACT) combine drugs with different mechanisms to reduce resistance risk. Supportive treatments include fluid replacement, antipyretics, and respiratory and circulatory support for severe cases.
Suitable for patients with confirmed or suspected malaria infection, especially those with travel history to endemic areas or mosquito bites. For Plasmodium vivax infections, primaquine is used to eradicate dormant liver stage parasites. Pregnant women should choose drugs safe for the fetus, such as quinine and doxycycline. Severe cases, such as cerebral malaria, require immediate hospitalization and intravenous medications.
Oral medications like artesunate are administered at 4 mg/kg on the first day, divided into 2-3 doses; quinine is typically 600-720 mg/day divided into multiple doses. Severe cases are treated with intravenous artesunate every 12 hours until symptoms improve. Primaquine should be used after the acute phase, usually at 0.5-1.5 mg/kg daily for 14 days.
Common side effects include nausea, diarrhea, and headache. Quinine may cause hemolytic anemia or tinnitus; long-term use requires hearing monitoring. Primaquine may induce hemolytic crises in G6PD deficiency patients and is contraindicated. Rarely, patients may develop liver enzyme abnormalities, requiring regular blood tests for monitoring.
Contraindications: Primaquine is contraindicated in G6PD deficiency; early pregnancy should avoid certain antimalarials like chloroquine unless otherwise specified. Patients should be checked for drug allergies before use, and those with severe liver or kidney dysfunction may require dose adjustments. Continued mosquito protection is necessary after treatment to prevent reinfection.
Concurrent use of antacids (such as acid reducers) may decrease quinine absorption; a 2-hour interval is recommended. Combining artemisinin with anticoagulant warfarin increases bleeding risk. When taking doxycycline, avoid sun exposure due to potential photosensitivity reactions.
WHO data shows that ACT can clear over 95% of parasitemia within 72 hours. In successful treatment cases from the 2010s, the mortality rate with timely use of ACT was 60% lower than with monotherapy. Genotypic drug sensitivity testing can help select effective drugs, especially in areas with drug-resistant malaria.
In regions with artemisinin resistance, combination therapies such as artesunate plus mefloquine are recommended. Chloroquine remains effective in areas without resistance, such as the Caribbean. For severe cases where artemisinin cannot be used, quinine combined with clindamycin is an alternative. Vaccination (such as RTS,S) can be used for prevention but not treatment.
Antimalarial drugs are usually taken with meals to reduce gastrointestinal discomfort, and the entire course of treatment must be completed even if symptoms improve. If vomiting occurs after taking medication, contact a doctor immediately to adjust timing or dosage to prevent resistance.
What side effects can antimalarial drugs cause? How can they be alleviated?Common side effects include nausea, diarrhea, or dizziness; severe reactions may include skin rashes or liver function abnormalities. Mild discomfort can be managed by dividing doses or taking with stomach protectants. If allergic reactions or persistent vomiting occur, stop medication and seek medical attention immediately.
How to prevent malaria relapse after completing treatment?Some parasites, such as hypnozoites in P. vivax, may remain dormant in the liver. After treatment, follow medical advice to take prophylactic drugs (e.g., primaquine) and undergo regular blood tests. Continue mosquito protection measures until the recovery period ends to avoid reinfection.
How long should patients rest before returning to normal activities after treatment?Patients with mild symptoms typically need 1 to 2 weeks of rest until liver and kidney functions recover, then gradually resume activities. Those with severe complications (such as coma or renal failure) should be evaluated by a doctor before gradually resuming physical activity to avoid overexertion.
What are the treatment challenges for cases with antimalarial drug resistance?Resistant cases require switching to combination therapies (such as artemisinin-based combination therapies, ACTs) or extending treatment duration, which may increase side effect risks. Doctors will select the most effective treatment based on resistance monitoring data in endemic areas, and patients must strictly follow dosing instructions.
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