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Management of severe malaria.

D A Warrell1

  • 1Centre for Tropical Medicine, University of Oxford, John Radcliffe Hospital, Headington, UK. david.warrell@ndm.ox.ac.uk

Parassitologia
|March 4, 2000
PubMed
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Severe falciparum malaria has a high fatality rate, but improved treatments and awareness are reducing deaths. Early chemotherapy for uncomplicated malaria may prevent severe disease progression.

Area of Science:

  • Tropical Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Severe falciparum malaria case fatality remains high (10-20%).
  • Improved antimalarial chemotherapy and complication awareness may lower hospital-treated case fatality.
  • Early treatment of uncomplicated malaria could prevent severe disease.

Purpose of the Study:

  • To review current and emerging treatments for severe falciparum malaria.
  • To evaluate the efficacy and safety of antimalarial drugs and ancillary treatments.
  • To identify needs for future research based on disease pathophysiology.

Main Methods:

  • Review of evidence on antimalarial chemotherapy regimens.
  • Assessment of artemisinin derivatives (suppository, intramuscular, intravenous) and quinine.

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  • Evaluation of ancillary treatments including antipyretics, anticonvulsants, anti-inflammatory agents, and others.
  • Consideration of supportive care like blood transfusion and organ support.

    • Main Results:

    • Artemisinin derivatives (oral, rectal, IV) and quinine are preferred treatments for severe malaria.
    • Evidence supports the safety and efficacy of quinine loading dose, artemether, and artesunate.
    • Ancillary treatments (antipyretics, anticonvulsants, anti-inflammatories, etc.) have shown disappointing results.
    • Supportive care for organ failure and blood transfusions are beneficial.

    Conclusions:

    • Early chemotherapy is crucial for preventing severe malaria.
    • Artemisinin derivatives and quinine are effective treatments for severe malaria.
    • Further research into pathophysiology-driven therapies is needed for severe malaria.