Treatment

Non-falciparum malaria

• Malaria caused by P. ovale, P. vivax and P. malariae can be treated in an/on outpatient basis (except in instances where the patient has other co-morbidities)
• Haemoglobin concentration should be measured
• glucose-6-phosphate dehydrogenase (G6PD) activity should be measured in patients with vivax or ovale since primaquinine therapy is needed to eliminate hypnozoites (dormant forms) from the liver
• patients with mixed infection (which includes falciparum parasites) and with an infection that cannot be speciated treatment should follow falciparum management

Falciparum malaria

• all patients with falciparum malaria infections should initially be admitted to the hospital
• due to the possibility of rapid progression and poor tolerance of oral therapies children also should be admitted to the hospital for at least 24 hours
• pregnant women, infants and the elderly should be monitored closely since they have an increased risk of developing severe disease or to deteriorate rapidly
• specialist advice should be sought in management of severe falciparum malaria (1)

Treatment alternatives are dependent on whether the patient has a severe (complicated) infection (with P. falciparum or other species), or the patient has an uncomplicated mild infection.

Reference:

• 1. Lalloo DJ et al. UK malaria treatment guidelines. Journal of Infection 2007;54:111-121