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Management of severe malaria.

Tanu Singhal1

  • 1PD Hinduja National Hospital and Research Centre, Mumbai, India. tanusinghal@yahoo.com

Indian Journal of Pediatrics
|February 26, 2004
PubMed
Summary

Prompt diagnosis and treatment are crucial for severe falciparum malaria outcomes. While artemisinin derivatives are increasingly used, their efficacy is comparable to quinine, necessitating rational drug use to prevent resistance.

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Area of Science:

  • Tropical Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Severe falciparum malaria requires prompt diagnosis and therapy for optimal outcomes.
  • Microscopy is the gold standard for diagnosis, with HRP-2 antigen/parasite LDH tests as alternatives.
  • Chloroquine resistance in Plasmodium falciparum necessitates alternative treatments in India.

Purpose of the Study:

  • To evaluate the comparative efficacy and safety of quinine versus artemisinin derivatives for severe falciparum malaria in India.
  • To emphasize the importance of rational drug use to prevent antimalarial resistance.
  • To highlight the role of supportive care and management of complications.

Main Methods:

  • Review of randomized controlled trials comparing quinine and artemisinin derivatives.
  • Assessment of drug resistance patterns in Plasmodium falciparum in India.
  • Discussion of diagnostic methods and supportive care strategies.

Main Results:

  • Artemisinin derivatives show no significant benefit over quinine in quinine-sensitive areas.
  • Quinine, when administered correctly, has comparable side effect profiles to artemisinins.
  • Artemisinin derivatives are increasingly used due to ease of administration, despite similar efficacy.

Conclusions:

  • Rational and judicious use of antimalarials is vital to prevent drug resistance.
  • Supportive care, early diagnosis, and complication management are as critical as antimalarial therapy.
  • Exchange blood transfusion may be considered for severe malaria with high parasite counts and multiorgan dysfunction, if safe blood is available.

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