Your doctor will probably recommend that you take a drug to help prevent a malaria infection, known as prophylaxis. If you develop malaria in spite of taking prophylaxis, your treatment will be different from what’s usually given to people with malaria who didn’t take preventive drugs. Treatment for malaria typically involves a combination of drugs to kill the disease-causing parasite. Your treatment will depend on what type of malaria you have, where you acquired the infection, and your health status, including any other drugs you take or medication allergies you have. (1)
Medication to Prevent Malaria (Prophylaxis)
These drugs are chosen by geographic region, since there are different patterns of infection and drug resistance depending on your area of travel. You’ll need to take your prophylaxis for the recommended duration before, during, and after your time in an area with widespread malaria transmission. Your need for malaria prophylaxis is still the same if you used to live in the area or if you’ve had malaria before. No medication provides 100 percent protection against malaria, so it’s still important to take other steps to reduce your risk of exposure to parasite-carrying mosquitoes. Your options for malaria prophylaxis may include: Atovaquone and Proguanil (Malarone) This drug combination tends to be well tolerated, with few side effects. It cannot be used by women who are pregnant or breast-feeding. Malarone should be started for prophylaxis one to two days before potential malaria exposure. It is taken daily, and must be continued for seven days after your trip. Chloroquine (Aralen Phosphate) This drug is considered safe during pregnancy, but it’s not an option in certain areas because of drug resistance. Chloroquine should be started for prophylaxis one to two weeks before potential exposure, is taken weekly, and must be continued for four weeks after your trip. Doxycycline (Vibramycin) This drug is an antibiotic that can also help prevent certain other infections. It’s not an option for pregnant women or young children, and side effects may include increased sun sensitivity, stomach upset, or vaginal yeast infections in women. Doxycycline should be started for prophylaxis one to two days before potential exposure, is taken daily, and must be continued for four weeks after your trip. Mefloquine (Lariam) This drug is considered safe during pregnancy, but it’s not compatible with certain psychiatric, seizure, and cardiac disorders. Lariam should be started for prophylaxis at least two weeks before potential exposure, is taken weekly, and must be continued for four weeks after your trip. Primaquine This drug is the most effective option for the Plasmodium vivax malaria parasite, but it’s not for pregnant women and may cause stomach upset. It also requires a test for a genetic defect called G6PD deficiency, and cannot be used in people who test positive. Primaquine should be started for prophylaxis one to two days before potential exposure, is taken daily, and must be continued for seven days after your trip. (1)
Deciding on a Treatment Plan
Which drug or combination of drugs you take to treat malaria, and the length of your treatment, will be based on several factors: Geographic Location of Infection Malaria parasites commonly become resistant to drugs, with different patterns of drug resistance seen in different areas of the world. Your doctor will choose a drug regimen that’s known to be effective against malaria parasites where you acquired the infection. Symptom Severity Severe malaria requires intravenous (IV) medication and hospitalization, rather than the oral drugs given for uncomplicated malaria. Severe malaria can be caused by any parasite species, but it’s most often caused by Plasmodium falciparum, the most common species in sub-Saharan Africa. Species of Malaria Parasite Malaria attacks red blood cells, and most drugs for malaria fight the parasite in your bloodstream. Infections with P. vivax or Plasmodium ovale species require additional medication to kill immature parasites that may be dormant in your liver. This is necessary to prevent a recurrence of the infection. Age Children will need smaller drug doses than adults, based on their weight. Pregnancy Some malaria drugs aren’t safe to take during pregnancy, or their safety in pregnancy is unknown. But it’s crucial for pregnant women to be treated for malaria. G6PD Deficiency Some malaria drugs can’t be taken by people who lack an enzyme called G6PD, so your doctor may test you for this deficiency before prescribing certain drugs. (1,2,3) Drug Availability Where you are located geographically when seeking treatment might limit the drugs readily available to you.
Medication to Treat Malaria
To reduce the risk of drug resistance, drugs for malaria are often given in combination. This helps kill off the parasite by targeting it in more than one way. It’s important to take the full course of your drugs as prescribed, and to acquire them from a reputable source. (2) Common side effects from various malaria drugs include:
NauseaBlurred visionHeadacheMouth soresRinging in your earsSensitivity to sunlight (4)
In the United States, guidelines for treating both uncomplicated and severe malaria include the following drugs: Artemisinin Combination Therapies (ACTs) This group of combination drugs, which includes artemether and lumefantrine (Coartem), is key to the current treatment of malaria caused by P. falciparum, the deadliest form. Artemisinin is derived from the “sweet wormwood” plant Artemisia annua, but synthetic variants of this chemical are often used instead. Chloroquine and Hydroxychloroquine (Plaquenil) Chloroquine and hydroxychloroquine are the first-line treatment for uncomplicated malaria without known drug resistance from Central America west of the Panama Canal, Haiti, the Dominican Republic, and most of the Middle East. Quinine (Qualaquin) This drug is used to treat chloroquine-resistant malaria. Quinine is derived from the cinchona tree of South America. Primaquine This drug is given to people with malaria caused by P. vivax or P. ovale to kill immature parasites in their liver. Primaquine is not an option for people with G6PD deficiency. Mefloquine This drug has been shown to cause potentially severe psychiatric symptoms in rare cases, and is contraindicated in those with a previous history of seizures or a recent history of psychiatric disorders. Atovarone and Proguanil This drug combination can cause stomach upset and should be taken with food or milk. Doxycycline, Tetracyline, and Clindamycin Doxycycline, tretracycline, and clindamycin are all antibiotics that are usually given for bacterial infections, but they also help disrupt the reproduction of malaria parasites. (1,3) Additional drugs approved to treat severe malaria in the United States include: Artesunate This is a first-line medication given by IV to people with severe malaria. Additional reporting by Quinn Phillips.
