Therapeutic targets
- Elimination of the pathogens
- Avoidance of complications
Therapy recommendations
- Patients with M. tropica are always treated as inpatients in Germany because of the possible severe course.
- In malaria tropica, it must first be determined whether organ complications have already occurred. Uncomplicated malaria tropica should be treated as an inpatient with ACT (“Artemisinin-based Combination Treatment”) (e.g., artemether/lumefantrine or dihydroartemisinin-piperaquine) or with atovaquone/proguanil (see below).Wg. resistances: Atovaquone/proguanil resistance only in rare individual cases; in Southeast Asia (north and west of Cambodia, south of Laos, east and central regions of Myanmar, Thailand and Vietnam) artemisinin-resistant pathogens of malaria tropica have been spreading at an alarming rate since 2012! For the first time, there are also malaria parasites resistant to artemisinin in Africa.
- In complicated malaria tropica, the following supportive measures are used:
- Antipyretics to reduce feverNote: No antiplatelet agents, but physical and/or with acetaminophen.
- Benzodiazepines for seizures.
- In case of malaria tertiana, chloroquine is the drug of first choice. Recommended here is a final treatment with primaquine (in African patients must first be excluded glucose-6-phosphate dehydrogenase deficiency).
- In malaria quartana, chloroquine is the drug of first choice.
- For P. snowlesi malaria, therapy is with ACT (“Artemisinin-based Combination Treatment”): e.g., artemether/lumefantrine or dihydroartemisinin-piperaquine.
- Malaria prophylaxis – see below the topic of the same name.
- See also under “Other therapy“.
Important notes
- With ACT (“Artemisinin-based Combination Treatment”) preparations (see above), daily ECG checks (due toQTc time prolongation) are initially necessary before and during therapy.
- Possible indications for treatment failure of ACT due to development of resistance are according to WHO criteria (day 0: start of therapy):
- Parasitemia and signs of severe malaria on day 1, 2, or 3;
- Parasitemia on day 2 (48 h) higher than on day 0;
- Parasitemia on day 3 with fever as well as.
- Parasitemia on day 3 that is ≥25% than that on day 0.
Usual with ACT treatment is a rapid decrease in parasitemia 24 h after the start of therapy!
