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Published on: October 11, 2019
Antimalarial treatment in infants
Laura C Kalkman1, Thomas Hanscheid2, Sanjeev Krishna3,4,5
1Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location Amsterdam, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Infants with malaria require tailored treatment due to unique physiological changes affecting drug response. Current guidelines often overlook this group, increasing risks of treatment failure and toxicity.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacology
- Global Health
Background:
- Malaria is prevalent in infants in high-transmission areas, particularly those over six months old.
- Infants experience physiological changes that alter drug pharmacokinetics and pharmacodynamics, impacting malaria treatment safety and efficacy.
- Existing malaria treatment guidelines and research frequently do not adequately address the specific needs of infants.
Conclusions:
- Further research, including dedicated infant trials and separate reporting of infant outcomes, is crucial.
- Additional data on the efficacy, safety, tolerability, and effectiveness of Artemisinin-based Combination Therapies (ACTs) in infants is needed.
- Population pharmacokinetic studies are essential to refine anti-malarial dosing and treatment regimens for infants.
Introduction:
Malaria in infants is common in high-transmission settings, especially in infants >6 months. Infants undergo physiological changes impacting pharmacokinetics and pharmacodynamics of anti-malarial drugs and, consequently, the safety and efficacy of malaria treatment. Yet, treatment guidelines and evidence on pharmacological interventions for malaria often fail to address this vulnerable age group. This review aims to summarize the available data on anti-malarial treatment in infants.
Areas Covered:
The standard recommended treatments for severe and uncomplicated malaria are generally safe and effective in infants. However, infants have an increased risk of drug-related vomiting and have distinct pharmacokinetic parameters of antimalarials compared with older patients. These include larger volumes of distribution, higher clearance rates, and immature enzyme systems. Consequently, infants with malaria may be at increased risk of treatment failure and drug toxicity.
Expert Opinion:
Knowledge expansion to optimize treatment can be achieved by including more infants in antimalarial drug trials and by reporting separately on treatment outcomes in infants. Additional evidence on the efficacy, safety, tolerability, acceptability, and effectiveness of ACTs in infants is needed, as well as population pharmacokinetics studies on antimalarials in the infant population.
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