MALARIA: THE DRUGS WE USE -

MALARIA: THE DRUGS WE USE

With two hundred million people in the most malarial part of the world, Nigeria possibly treats more malaria cases than any other country in the world. This discussion on treatment of malaria is therefore based on treatment of Plasmodium falciparum malaria in Nigeria. The main drugs we shall discuss are Artemisinin-based Combination Therapies (ACTs), drugs for the treatment of severe malaria, agents for prevention (chemoprophylaxis), and a few others.

For Plasmodium falciparum, medical authorities recommend use of more than one drug taking advantage of drugs with different modes of action, drugs having effectiveness on different forms of the parasites (such as blood schizonts and liver merozoites), drugs with different onsets of actions, and drugs with different durations of action such that the drug combination has an overall effectiveness and reliability in killing the plasmodia, achieving cure, and can prevent development of resistant strains of the parasite.

Drug combinations also allow us to reduce the respective doses of the drugs combined and thus reducing side effects.  Pharmaceutical industries have developed several combinations which are marketed as prescription drugs and over-the-counter drugs.    The well-established combinations are:

  1. Artemether plus lumefantrine
  2. Artemether plus lumefantrine plus paracetamol
  3. Artemisinin plus piperaquine
  4. Artesunate plus amodiaquine
  5. Artesunate plus mefloquine
  6. Artesunate plus sulfadoxine plus pyrimethamine
  7. Artesunate plus pyronaridine
  8. Dihydroartemisinin plus piperaquine
  9. Dihydroartemisinin plus piperaquine plus trimethorprim

Artemisinin-based Combination Therapies (ACTs) are the most popularly used for treatment of malaria and are the most reliable for common or routine treatment of malaria.  They are regarded as first line drugs that are used before other alternatives. They are generally safe drugs when used according to manufacturer’s instructions.  They are popularly known by their trade names.

Examples are: Camosunate which is an ACT manufactured in China and contains artesunate (100mg) plus amodiaquine (300 mg); P-Alaxin TS is an ACT manufactured in India and contains dihydroartemisinin (120 mg) plus piperaquine phosphate (960 mg); and Gloatem Forte is an ACT manufactured in India and contains artemether (80 mg) plus lumefantrine (480 mg). There are numerous other trade names of ACTs belonging to different drug manufacturers.  EMDEX – The Complete Drug Formulary for Nigeria’s Healthcare Professionals – (2019-2020 Edition) lists two hundred and twenty (224) ACTs according to their trade names.

 

Because of issues of age, sex, drug allergy, pregnancy, liver function status, finance, etc., particular ACT formulations may be preferable therefore it is important to seek a DOCTOR’S prescription even if many of these drugs are available over the counter.  Always ask your pharmacist for advice when making an over the counter ACT purchase.

Because of the nature of the malaria parasite’s life cycle and the adaptability of the parasite within the human host, a person who tends to have malaria often may change formulations to use, for example, for one episode artemether plus lumefantrine and for the next episode artesunate plus amodiaquine, and possibly back to artemether plus lumefantrine for a third episode.  People who take antimalarials frequently may try such methods to prevent hosting of resistant parasites in body tissues.

Sourced from: THENATION

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