Treatment
![drugs drugs](media/Graphic-14v2-drugs.jpg)
For falciparum malaria, treating the early uncomplicated stages is far easier than treating it once it has progressed to the severe form of the disease. It is therefore extremely important that patients receive treatment as early as possible.
As soon as malaria is suspected medical help should be sought and a diagnostic test carried out. If the test is positive, treatment should begin immediately. The drugs should be taken exactly as indicated, the right quantities at the right time and with food if this is recommended. The full course should be completed even if the patient starts to feel better.
![Artemisinia (source William Daniels (c) (for Malaria Consortium) Artemisinia (source William Daniels (c) (for Malaria Consortium)](media/Graphic-15v2-Artemisinia.jpg)
While every drug has potential side effects, modern malaria treatments are safe and most are well tolerated.
Drugs used commonly until recently to treat falciparum malaria such as chloroquine, and sulfadoxine-pyrimethamine, face widespread drug resistance problems. Almost all countries worldwide, including all countries in the Asia-Pacific region now recommend artemisinin based combination therapies (ACTs) for treatment of uncomplicated falciparum malaria.
In all but a few areas in the Greater Mekong Sub-region (GMS) artemisinin derivatives are highly effective against all malarias. In ACTs an artemisinin derivative is combined with another drug for better combined effect as well as to try to slow the development and spread of drug resistance, by ensuring parasites not killed by one of the drugs will likely be killed by the other. The drug used in partnership with the artemisinin derivative varies, and is selected based on resistance to the different options in any given area.
ACTs come in tablet form with the two types of drug already combined. Different brands are available and different tablet dosages. Commonly the treatment course will be over several days and it is essential that the course is completed.
Vivax malaria has traditionally been treated with chloroquine partnered with a 14 day course of primaquine. The primaquine is included to clear the dormant liver stages of the vivax parasite (this long course of primaquine is not required for falciparum malaria as it does not develop dormant liver stages). In many places this treatment remains effective for vivax malaria and it is still recommended in some settings. However, in many places vivax malaria is now treated with ACTs, in combination with primaquine. This is the case where vivax has developed resistance to chloroquine, as well as in the many locations worldwide where falciparum and vivax are co-endemic and mixed infections are common.
![G6PD test kit G6PD test kit](media/Graphic-16-G6PD-test-kit.jpg)
In order to prevent onward transmission of disease from patients being treated for falciparum malaria with ACT the WHO now recommends a single low-dose primaquine treatment to quickly clear the specialized parasite stages in the blood that are infective to mosquitoes. Without this primaquine treatment patients can remain infective to mosquitoes for some days following their cure.
ADDITIONAL RESOURCES
on malaria diagnosis, treatment and drug resistance