• Definition
• Symptoms
• Causes
• Risk factors
• Complications
• Preparing for your appointment
• Tests and diagnosis
• Treatments and drugs
• Prevention

• RSS Feeds

Treatments and drugs

By Mayo Clinic staff

Medications
A malaria infection, particularly with P. falciparum, requires prompt evaluation and treatment. In most cases, doctors can treat malaria effectively with one or more of the following medications:

• Chloroquine (Aralen)
• Quinine sulfate (Qualaquin)
• Hydroxychloroquine (Plaquenil)
• Combination of sulfadoxine and pyrimethamine (Fansidar)
• Mefloquine (Lariam)
• Combination of atovaquone and proguanil (Malarone)
• Doxycycline (Doryx, Vibramycin, others)

• Artemisinin-derived medications. Another class of antimalarial drugs, often prescribed in Asia and now in other parts of the world, is derived from artemisinin, a sweet wormwood extract. Artesunate is an example of an artemisinin derivative.
• Halofantrine. Doctors sometimes use halofantrine to treat malaria, although it's not marketed in the United States. If you've been taking mefloquine for prevention of malaria or if you have heart problems, don't take halofantrine because it can be dangerous and possibly fatal.
• Primaquine. This drug may be given to fight the dormant liver form of the parasite and prevent relapses. However, the Centers for Disease Control and Prevention (CDC) has warned against taking primaquine if you're pregnant or have an enzyme deficiency called glucose-6-phosphate dehydrogenase (G6PD) efficiency. Don't take primaquine until you've passed a screening test for G6PD deficiency.

Which drug you take and the length of treatment depend on the type of malaria, where you were infected, your age and how sick you were when treatment began. Drugs are given either orally or intravenously, depending on the severity of illness. In some countries, they may be given in suppository form. After treatment, you may feel very weak and tired for a few weeks.

The problem of drug resistance
The history of antimalarial medicine has been marked by a constant struggle between evolving drug-resistant parasites and the search for new drug formulations. In many parts of the world, for instance, resistance to chloroquine has rendered the drug ineffective.

Currently, anti-malaria experts are focusing on therapies that combine artemisinin derivatives with other companion drugs. These combinations are referred to as artemisinin-based combination therapy (ACT). Artemisinins act quickly in your bloodstream, rapidly clearing away parasites and helping you feel better faster. They may also help reduce transmission of the disease by reducing the number of gametocytes — the infective version of the parasite — in your bloodstream. There's little documented resistance to artemisinins, and their combination with other drugs may slow resistance to these companion drugs as well. In addition, ACT has few known side effects.

The downside of these combination drugs is that they are often more expensive than conventional antimalarials. Also, doctors must be careful in selecting companion drugs for different geographical regions, in order to avoid administering drugs for which resistance is already present and weakening the effect of the combination therapy.

One of the goals of malaria research is to find companion drugs that haven't already been used as antimalarials, thus lessening the risk of drug resistance. More research is also needed to prove the safety and effectiveness of combination therapies, particularly with regard to children and pregnant women.

Print Share Reprints

Check out these best-sellers and special offers on books, newsletters and DVDs from Mayo Clinic.

• Try Mayo Clinic Health Letter free!
• Mayo Clinic Guide to Pain Relief
• Mayo Clinic Five Steps to Controlling High Blood Pressure
• Get your free trial issue of Women's HealthSource!

COMING SOON! — The Mayo Clinic Diet book