Treating uncomplicated malaria with single oral anti malarial drug negligence

Suspect malaria in any febrile illness: IMA

Treating uncomplicated malaria with single oral anti malarial drug negligence

On the occasion or World Malaria day to be observed on 25th Aril, IMA has come out with guidelines for public and physicians.

Giving the details Padma Shri Awardees, Dr A Marthanda Pillai National President and Dr K K Aggarwal Honorary Secretary General Indian Medical Association, said that malaria should be suspected in patients with any febrile illness. The initial symptoms and signs of malaria are nonspecific and may also include high pulse rate, high respiratory rate, chills, rigors, malaise, fatigue, sweating, headache, cough, loss of appetite, nausea, vomiting, abdominal pain, diarrhea, joint pains and muscular pains.

Groups at high risk for severe malaria and its consequences include young children (6 to 36 months) and pregnant women.  Older children and adults develop partial immunity after repeated infection and are at relatively low risk for severe disease.

Travelers to areas where malaria is endemic generally have no previous exposure to malaria parasites and are at very high risk for severe disease if infected with Plasmodium falciparum.

The incubation period for P. falciparum infection is usually 12 to 14 days as agaist dengue which is 4-10 days. Longer incubation periods are more likely in semi-immune individuals and individuals taking inadequate malaria prophylaxis at the time of infection. The relapsing malarias (P. vivax) can cause clinical illness several weeks or months after the initial infection.

Rapid diagnostic tests for detection of malaria antigens are accurate and easy to use. They require no electricity or lab infrastructure, give results within 15 to 20 minutes. However they provide a qualitative result but cannot provide quantitative information regarding parasite density.

Uncomplicated malaria consists of symptomatic malaria without evidence of vital organ dysfunction and parasite count of less than 5% with the ability to take oral therapy. 

Giving monotherapy of oral anti malarial drug in uncomplicated malaria may amount to negligence

Artemisinin derivatives are the only rapidly acting anti- malarials as of date and if used alone, can lead to the development of artemisinin resistance.

Hence, they should not be administered as monotherapy for uncomplicated malaria except for specific studies on artemisinin resistance as injectables for severe malaria.

Injectable artemisinin derivatives should be used only in severe malaria.

Using these drugs in uncomplicated malaria may amount to negligence said Padma Shri Awardees, Dr A Marthanda Pillai National President and Dr K K Aggarwal Honorary Secretary General Indian Medical association.

Drugs Controller General of India banned oral single drug formulations of artemisinin and its derivatives in July 2009. WHO recommends access to quality-assured artemisinin-based combination therapies (ACTs) only.

For oral artemisinin-based monotherapies to be effective in eliminating malaria parasites, they need to be taken as a full seven-day treatment course. However, due to the rapid clinical response – i.e. clearance of signs and symptoms within 2-3 days – most patients do not complete the full regimen leading to resistance.

Artemisinin-based therapies are the mainstay of recommended malaria treatments today, and their efficacy must be preserved, as no new class of antimalarial medicines is expected to enter the market within the next few years.

The anti-malaria drug artemisinin and its derivatives are artesunate and artemether