ISSN - 0973-0958

Pediatric Oncall Journal

Malaria treatment

Malaria treatment

Dr Ira Shah.
Medical Sciences Department, Pediatric Oncall, Mumbai.

Clinical Problem
A 10 years old boy born of non consanguineous marriage presented with fever with chills, pain in right hypochondriac region since 10 days and diarrhea since 3 days. There is no history of jaundice, bleeding or blood transfusion. On examination, vital parameters were normal. Child had pallor with hepatosplenomegaly. Other examination findings were normal.
Investigations showed:-
? Hemoglobin = 7.8 gm percent
? WBC count = 2,800, cumm {68 percent polymorphs, 29 percent lymphocytes}
? Platelet count = 56,000, cumm
? Total Bilirubin = 2.1 mg, dl {Direct bilirubin = 1.1 mg, dl}
? SGPT = 33 IU, L
? S. creatinine = 1.5 mg, dl
? Peripheral smear = Gametocytes of plasmodium falciparum
? OptiMAL test = Plasmodium falciparum positive
? Dengue, Leptospira = Negative

Child was treated with oral quinine and IV Artesunate to which he responded.

Can artesunate and quinine be given together_?
Artemisinin compound has been used in China for treatment of malaria for over a thousand years. It has a broad spectrum activity against all stages of malarial parasite as well as all 4 plasmodium species. In falciparum malaria, it is also gametocidal. The elimination half-life is approximately 1 hour and thus they are potent short acting agents. The common side effects are gastrointestinal disturbances, dizziness, tinnitus and prolongation of QT interval.
Quinine is derived from bark of Cinchona tree. It acts on the mature trophozoite stage of parasite development. The elimination half life is about 11 hours in healthy individuals, 16 hours in uncomplicated malaria and 18 hours in severe malaria. Adverse effects are common and include tinnitus, impaired high pitch hearing, vomiting, urticaria, hemolytic-uremic syndrome, hypoglycemia and prolonged QT interval on ECG {seen in intravenous quinine}.
Since plasmodium falciparum has been found to be resistant to most of the currently used antimalarials, combination therapy with antimalarials is now recommended. The combination consists of two or more blood schizonticidal drugs and includes a combination of a short acting antimalarial with a long acting antimalarial. Both artemisinin compounds and quinine are short acting and have common side effects. Hence they should not be used together.
Combinations that are recommended are:
• Artesunate {short acting}plus Mefloquine {long acting}
• Artesunate {short acting}plus Sulfadoxine-pyrimethamine {long acting}
• Artemether {short acting} plus Lumefantrine {long acting}
• Quinine plus Clindamycin
• Quinine plus Tetracycline, Doxycycline
Compliance with ethical standards
Funding:  None  
Conflict of Interest:  None
Cite this article as:
Shah I. Malaria treatment. Pediatr Oncall J. 2011;8: 29-30.
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
Disclaimer: The information given by is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0