[1998 malaria therapy]

A review of the principal antimalarial drugs is presented as the basis for specific recommendations on the treatment of malaria. These are adapted to conditions in Switzerland. Considering that the majority of Plasmodium falciparum infections imported into this country are acquired in areas with a high prevalence of chloroquine resistance, mefloquine is generally considered the first-line drug for the treatment of uncomplicated falciparum malaria. For severe tropical malaria, or if parasitaemia exceeds 2%, quinine remains the drug of choice. The pharmacological decision must estimate the risk of drug-resistant malaria and consider the clinical condition, possible intolerance and drug interactions. Prognosis is always difficult in falciparum malaria; hence hospitalization is always strongly recommended if the course is in doubt and if close monitoring of the patient is not otherwise guaranteed. In hospital, ancillary treatment (e.g. exchange transfusion) must receive timely consideration. Special considerations must be borne in mind with regard to the treatment of malaria in children and during pregnancy.