Treatment Of Malaria

, , Leave a comment

Malaria is a remittent fever caused by protozoa which resides inside red blood cells of human being. It is transmitted by female Anopheles mosquitoes in tropical and sub tropical regions. It is a life threatening disease caused by protozoan parasites from plasmodium family. Human malaria likely originated in Africa. Humans may have originally caught plasmodium from Gorillas. In ancient times, due to mass migration of human population from Africa to other continents of Earth, malaria spread to other countries of the World too. Malarial parasites reside inside red blood cells of human beings. That is why; it can also be transmitted through shared use of syringes, during blood transfusion, during organ transplantation and from pregnant women to her young one.

Primarily, four types of plasmodium species infect human beings. That are:-

Plasmodium falciparum

Plasmodium vivax

Plasmodium ovale

Plasmodium malariae

There is another type of malaria found known as ‘zoonotic malaria’. This type of malaria is transmitted from animals to humans by plasmodium knowlesi.Till date, this type of malaria is confined to only South East Asian countries .

Most of the malaria infections are caused by plasmodium falciparum species. According to a report by WHO, every year about 15,000 cases of malaria are diagnosed in United States of America. Among all, travelers and immigrants returning from sub-Saharan and South East Asian Countries come under high risk group.


Only female Anopheles mosquitoes are known to transmit malaria from a diseased person to a healthy one. When female anopheles bites an infected person, blood of infected person containing malaria parasite transmits in mosquito. When this mosquito bites a healthy person than the malaria parasite mixes with the saliva of mosquito and enters in blood of healthy one. This parasite passes from red blood cells to the liver of victim where it reproduces and changes its form. After a period of 1 to 4 weeks the parasite re-enters blood where it infects red blood cells, performs more reproduction inside red blood cells. This cause a bursting of RBC, resulting in fever, shivering, chills and aches inside the infected one.

Symptoms and diagnosis:

Symptoms of malaria may appear within 7 days of mosquito bite. Generally incubation period ranges from 9 to 14 days in P.falciparum, 12 to 18 days in P.vivax and 18 to 40 days in P.ovale.Common symptoms of malaria include fever with shivering, headache, nausea, vomiting and anemia. If not treated properly, organ failure, loss of consciousness and even coma may result due to this life threatening infection. Suitable diagnosis should be performed to trace out the infection as soon as the symptoms appear. Microscopic diagnosis is done to see the presence of parasites in blood of infected person. In addition to microscopy, antigen detection tests such as RDT that is rapid detection test is approved in USA.A second type of test is polymerase chain reaction, which detects malarial DNA in blood of infected one.


Malaria should be treated as soon as its diagnosis is complete. Treatment of malaria is guided by three main factors.

First is-Detection of infecting plasmodium species: Different plasmodium species have different effect on human which affects treatment accordingly. For example,P.vivax and P.ovale may remain dormant in liver of infected person for one to several years. They may cause relapsing infection. Infection caused by P.vivax and P.ovale species need treatment in hypnozoite form to prevent recurring infections.In the same way,P.falciparum has different drug resistant pattern in different geographical areas. Where no specific species of plasmodium is detected than treatment is done according to P.falciparum infection.

Second is-Clinical status of patient: Two types of patients are found in case of malaria. First one has general or uncomplicated symptoms. In this case oral anti-malarial drugs must be given to kill the infection. Second type of patient may have severe infection. That is presence of mixed infection where hemoglobin level is less than 7.In these types of patients’ hypotension and other complexities like convulsions, loss of consciousness and, edema are also found. These patients are treated according to anti-malarial therapy.

Third point to be considered before starting treatment is Drug susceptibility: Knowledge of geographical area from where infection has been acquired is necessary for appropriate treatment. Proper drug or a combination of drugs is given to the patients for killing infection.

A guideline has been provided in 2015which is based on the current availability of drugs in United States. We can summarize the complete guideline in tabular form as below:

Treatment based on guideline by CDC: updated on July 2015:

Plasmodium species Region from infection acquired Drugs for adults Pediatric dose
Uncomplicated malaria/species not identified/or plasmodium falciparum Chloroquine resistance/unknown resistance A) .atovaquone-proguanil

Adult tablet-250mg atovaquone /100 mg proguanil

4 adult tablets po(per oral) qd for 3 days


Ped tablet-62.5mg atovaquone/25mg proguanil.

5-8kg- 2 ped tab po qd for 3 days

9-10kg-3 ped tab po qd for 3 days

11-20kg-1 adult tab po qd for 3 days

21 -30 kg -2 adult tabs po qd for 3 days

31-40 kg-3 adult tabs po qd for 3 days

More than 40 kgs-4 adult tab po qd for 3 days.




1 tab=20mg artemether/120mg lumefantrine

A three day treatment schedule with 6 oral doses is recommended for both adults and children.First dose is initial, second dose is given after 8 hours than 1 dose po bid for the following 2 days.

5 -15 kg- 1 tablet per dose

15-25 kg -2 tablets per dose

25 -35 kg-3 tablets per dose

More than 35 kg -4 tablets per dose


As mentioned in column for adults
C)quinine sulfate+one of the following doxycycline,tetracycline or clindamycine

Quinine sulfate-542mg base(=650 mg salt)po tid for 3 days or for 7 days.

Doxycycline=100mg po bid for 7 days

Tetracycline=250 mg po qid for 7 days.

Clindamycin=20mg base/kg/day po divided tid for 7 days.

Quinine sulfate+one of the following drugs:

doxycycline,tetracycline or clindamycin.

quinine sulfate=8.3 mg base/kg (=10 mg salt/kg)po tid for 3 or 7 days.

doxycycline=2.2 mg/kg po every 12 hours for 7 days.

tetracycline=25 mg/kg/day po divided qid for 7 days.

clindamycin=20mg base/kg/day po divided tid for 7 days.

D) mefloquine

684mg base (=750 mg salt)po as initial dose,followed by 456 mg base(=500 mg salt)po given 6 to 12 hours after initial dose.

Total dose=1,250 mg salt.


13.7base/kg (=15 mg salt/kg)po as initial dose,followed by 9.1 mg base/kg (=10mg salt/kg)po given 6 to 12 hours after initial dose.

Total dose=25 mg salt/kg


Note:Suitable medical advice must be taken before taking any medicine. Any type of treatment A, B, C, D can be given for uncomplicated malaria caused by chloroquine- resistant plasmodium.Treatment with Mefloquine is not given when a person acquires malaria from South East Asian countries.Primaquine is used to eradicate hypnozoites that may remain dormant in liver and thus prevents relapsing infections by p.vivax and p.ovale.Primaquine cause hemolytic anemia in G6PD deficient persons.So,G6PD screening should be done prior to treatment with primaquine.


Uncomplicated malaria/p.falciparum or species not identified Chloroquine sensitive region

(west of panama region,central America,Haiti,Middle East,The Dominician Republic)



chloroquine phosphate


600 mg base (=1,000 mg salt)po immediately, followed by 300 mg base(=500 mg salt)po at 6,24 and 48 hours.

Total dose=1,5oo mg base(2,5oo mg salt)




620 mg base(800mg salt)po immediately,followed by 310 mg base(=400mg salt)po at 6,24,48 hours.

Total dose=1,550 mg base(=2,000 mg salt)



chloroquine phosphate

10 mg base/kg po immediately followed by 5 mg base/kg po at 6, 24 and 48 hours.

Total dose:25 mg base/kg








10 mg base/kg po immediately,followed by 5 mg base/kg po at 6,24,48 hours.


Total dose=25 mg base/kg.

Uncomplicated malaria/p malariae or p.knowlesi All regions chloroquine phosphate(treatment as above) OR hydroxychloroquine

(treatment as above)

chloroquine phosphate(treatment as above) OR hydroxychloroquine

(treatment as above)

Uncomplicated malaria.

p.vivax or p.ovale

All regions chloroquine phosphate+primaquine phosphate.

chloroquine phosphate;Treatment as above

primaquine phosphate: 30 mg base po qd for 14 days.





hydroxychloroquine+primaquine phosphate.

Hydroxychloroquine: Treatment as above.

Primaquine phosphate: 30m mg base po qd for 14 days.

chloroquine phosphate+primaquine phosphate.

chloroquine phosphate:Treatment

as above.

primaquine phosphate:o.5 mg base

/kg po qd for 14 days.








hydroxychloroquine:Treatment as above.

primaquine phosphate:

0.5 mg base/kg po qd for 14 days.

Uncomplicated malaria/p.vivax Chloroquine-resistant

(Papua New Guinea and Indonesia)

A) quinine sulfate+either doxycycline or tetracycline+primaquine phosphate.

quinine sulphate:treatment as above.

doxycycline or tetracycline:treatment as above.

primaquine phosphate:treatment as above

A) quinine sulfate+either doxycycline or tetracycline+primaquine phosphate.

quinine sulphate:treatment as above.

doxycycline or tetracycline:treatment as above.

primaquine phosphate:treatment as above

B)atovaquone-proguanil+primaquine phosphate

atovaquone-proguanil:treatment as above.

primaquine phosphate:treatment as above.


B)atovaquone-proguanil+primaquine phosphate

atovaquone-proguanil:treatment as above.

primaquine phosphate:treatment as above.




mefloquine+primaquine phosphate.

mefloquine:treatment as above

primaquine phosphate:treatment as above.


C) mefloquine+primaquine phosphate.

Mefloquine:treatment as above

primaquine phosphate:treatment as above.


For pregnant women diagnosed with uncomplicated malaria caused by chloroquine resistant p.falciparum or chloroquine resistant p.vivax infection,no treatment with doxycycline or tetracycline is done, generally.However,these drugs may be given in combination with quinine.

For p.vivax or p.ovale infections,primaquine phosphate for radical treatment of hypnozoites should not be given to pregnant ladies. They should be given chloroquine prophylaxis during the whole gestation period.Chemoprophylactic dose of chloroquine is 300 mg base (=500 mg salt) orally once a week. However, suitable advice from Doctor is must prior to the treatment of pregnant ladies.

Malaria is common in poor tropical and sub-tropical regions. Among all the Nations of World, Africa is the most affected continent. Presence of plasmodium species, favorable climate and an abundance of transmitter mosquitoes are the main reasons behind occurrence of malaria. Young children and pregnant ladies come under high risk group of catching malaria. Prevention is better than cure. A large numbers of programmed are being run by the Government of affected Countries to eliminate malaria like larval control, mass drug administration, indoor residual spraying (IRS), insecticides treated nets, intermittent preventive treatment of malaria in pregnancy and intermittent preventive treatment in children. From all these measures applied, we may hope that soon malaria would be eradicated Globally.So,lets hope for a better future.

Tea Time Quiz

[forminator_poll id="23176"]

Leave a Reply