Definition
Otherwise known as " paludism ", malaria undoubtedly plays an important role among all parasitoses, both in terms of diffusion and danger; when not treated in time, malaria is in fact deadly. The disease is widespread in South America, Asia and Africa, but can also affect some industrialized countries (eg USA).
Causes
Malaria is transmitted to humans through the bite of female mosquitoes belonging to the genus Anopheles, in turn infected with protozoa (genus: Plasmodium); in other words, this mosquito plays the role of the vector of the disease, and is therefore able to infect a healthy individual after having stung a malaria subject.
Symptoms
Generally, malaria is characterized by recurrent episodes of high fever alternating with chills and sweating; some patients also complain of anemia, confusion, convulsions, diarrhea, jaundice, headache, nausea and vomiting.
- Complications: accumulation of lactic acid in the body, pulmonary edema, renal failure, hyperparasitemia, hypoglycemia, dehydration hypovolemia
Typically, the typical symptoms of malaria begin a few weeks after the infection (corresponding to the bite of the Anopheles mosquito), although some malaria parasites may remain silent in the body for months or years.
Information on Malaria - Drugs for the treatment and prevention of Malaria are not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Malaria - Medicines for the treatment and prevention of Malaria.
drugs
The choice of a drug or treatment to treat malaria depends on the infecting parasite, the severity of the symptoms and the age of the patient; moreover, particular attention must be paid to the care of pregnant women suffering from malaria, especially in the last quarter.
Although the choice of active drugs against malaria parasites is quite wide, it is good to keep in mind local resistance, which often hinders the effectiveness of the drug at standard doses.
If the pest species is not diagnosed with certainty, the patient is generally treated with quinine derivatives or with the combination of proguanil + atovaquone, a typical pharmacological combination used to treat Plasmodium falciparum infection, the most dangerous parasite for malaria transmission.
In extreme cases, difficult to resolve, malaria is treated with intravenous artesunate.
- Quinine (eg Chin CL SAL, Chin CL AID): used in therapy both to treat P. falciparum malaria, and to treat malaria of unknown aetiology. It is not used for chemoprophylaxis. It is recommended to take a drug dose of 600 mg by mouth (such as quinine hydrochloride, quinine dihydrochloride or quinine sulfate) every 8 hours for 5-7 days. It is also recommended to follow therapy in combination with doxycycline (200 mg, once a day for a week). Only rarely, if the patient's condition prevents him from taking the drug orally, quinine is administered by slow intravenous infusion.
- Chloroquine (eg Chloroquine, Cloroc FOS FN): in monotherapy, chloroquine is poorly used due to drug resistance, except for those cases of benign malaria, caused by drug-sensitive strains; however, chloroquine is used in association with other active ingredients, such as quinine / proguanil associated with atovaquone, artemether or lumefantrine. For the dosage consult your doctor.
- Hydroxychloroquine (eg Plaquenil): the drug belongs to the class of antimalarial quinolones and is often used in therapy for the treatment of malaria. To treat acute attacks of malaria, it is recommended to take 800 mg of active ingredient; after 4-8 hours, take a second 400 mg dose. Continue therapy by taking 400 mg of drug a day for 2 consecutive days. Alternatively, a single 800 mg dose can be taken. In general, the dosage must be improved based on the patient's weight. Each dose of the drug should be taken with a glass of milk or with a full stomach, never fasting.
- Piperachin tetraphosphate and dihydroartemisinin (ES. Eurartesim): the drug is available in tablets formulated with 160 mg of piperaquine tetraphosphate and 20 mg of dihydroartemisinin; it is possible to take the pharmacological preparation for the treatment of uncomplicated malaria (caused by P. falciparum). Do not administer in children under the age of 6 months, who weigh less than 5 kilos. As an indication, take one tablet a day for three consecutive days, preferably always at the same time, with or without food, within three hours of the meal. Consult your doctor.
- Mefloquine (eg Lariam): second-choice drug for the treatment of malaria, due to the induction of resistance. It is possible to take the drug both for the prevention and treatment of malaria; however, if the drug has already been taken for chemoprophylaxis, it is not recommended to administer it again for the treatment of the disease in case of proven infection. However, mefloquine is used as an alternative to chloroquine, in those patients who have developed active resistance to it.
For the prophylaxis of malaria, take 250 mg of oral medication once a week, after the main meal, remembering to always take it on the same day. The therapy must be started a couple of weeks before departure and must be terminated 4-5 weeks after the return.
For the treatment of malaria, the drug should instead be taken at an indicative dose of 1250 mg (corresponding to 5 tablets) in a single dose; alternatively, it is possible to take the active ingredient at a dosage of 750 mg (in a single dose), followed by 500 mg, 6-12 hours after the first intake. Take the medicine with plenty of water.
- Pyrimethamine (eg Pirimeta FN, Metakelfin): the drug is an antimalarial used almost exclusively in the prophylaxis of malaria. Take 25 mg of oral medication once a week. Begin therapy one week before departure and finish the treatment after 6-10 weeks of hypothetical exposure to the virus. The dosage for children under the age of 4 is 6.25 mg (once a week); for children aged between 4 and 10, the recommended dose is double. Consult your doctor.
- Proguanil: this antimalarial drug (eg Paludrine) is not indicated for treating malaria; rather it is prescribed for its prevention. In monotherapy, the drug is taken indicatively at a dose of 200 mg (dose for adults and for children over 14 years); for infants and for children who have not yet turned 14, the dose of the drug varies according to age and weight (from 25 to 150 mg per day). As for the duration, the preventive treatment must be started a week before leaving for the places where malaria is widespread, and it must be extended up to 4 weeks after the return. However, proguanil is used mainly in combination with other specific drugs: for the treatment of acute malaria without complications, it is recommended to take 250 mg of atovaquone and 100 mg of proguanil hydrochloride (eg Malarone). This pharmacological association is a valid alternative to mefloquine and chloroquine.
Notes: proguanil, atovaquone, artemether and lumefantrine drugs can be administered orally if the patient is able to swallow and there are no serious manifestations associated with malaria. It is generally possible to take these drugs during pregnancy, after consulting a doctor.
- Clindamycin (eg Dalacin-T , Clindamycin BIN , Zindaclin , Dalacin-C): the indication of this drug for the treatment of malaria is not approved in some countries, such as Italy and Great Britain. However, the indicative dosage involves taking the drug at a dose of 450 mg every 8 hours for 5 days, or at a dose of 900 mg, orally, every 8 hours for 5 days, associated with quinine sulfate (650 mg every 8 hours, for 3-7 days). The drug, in the countries where it is used, can also be taken during pregnancy.
- Artemether and lumefantrine (eg Coartem): even this pharmaceutical combination, just like the previous drug, is not marketed in Italy. In some states, it is possible to take this product for the treatment of uncomplicated malaria, from P. falciparum . Consult your doctor.
- Doxycycline (eg Doxicicl, Periostat, Miraclin, Bassado): the drug belongs to the class of tetracycline (antibiotics), and is used in therapy for malaria prophylaxis, especially in those areas of resistance to chloroquine and mefloquine. The dosage foresees to take 100 mg of active by mouth, twice a day for 7 days; it is recommended to combine a parallel therapy with quinine sulfate (650 mg) every 8 hours, for 3-7 days. Do not take during pregnancy: it may alter the normal coloring of the newborn's teeth.
- Artesunato: the active ingredient (extracted from the Artemisia annua plant) is a derivative of artemisinin, a powerful antimalarial. The drug is used in extremely severe cases of malaria and is administered intravenously or intramuscularly. Indicatively, the first dose involves taking 2 mg / kg of drug; the second, to be taken after 12 hours, foresees to administer 1 mg / kg of active. Proceed with the same administration for the third dose (after 12 hours). For subsequent doses, proceed by taking 1 mg / kg of drug per day, until you reach the cumulative dose of 10 mg / kg. Then it is possible to proceed with the administration by os. Consult your doctor.
The best cure is prevention: it is essential to avoid the bite of the Anopheles mosquito (by applying repellents on skin and clothes), avoid going out during the first hours of the morning or night (moments of the day when the probability of being bitten by mosquitoes increases ), protect yourself with mosquito nets, wear long-sleeved clothes, leave no body parts exposed.
Non-immune subjects who go to areas at risk of malaria should follow a pharmacological prophylaxis (chemoprophylaxis with chloroquine or other antimalarial drugs): compliance with these simple rules, even if trivial, can prevent malaria.
Several malaria vaccines are currently undergoing advanced testing, with encouraging premises. One of these (Mosquirix ®) was approved by the EMA - the European Medicines Agency - in July 2015.
