Early and accurate diagnosis with urgent treatment using the correct drugs is the key to successful management. It is important to differentiate uncomplicated from severe malaria. If possible all patients with malaria are referred to a hospital or clinic where the staff are experience in treating malaria. They must be closely followed up for the first few days. Patients with confirmed malaria are usually treated with coartemether (Coartem). Coartem is a combination of two potent, rapidly acting anti-malarial drugs which are well tolerated.
For uncomplicated malaria, one dose of Coartem should be taken immediately, then again after 8 hours, followed by a twice daily dose for the next 2 days. Each dose is 1 tablet if 10–14 kg, 2 tablets if 15–24 kg, 3 tablets if 25–34 kg and 4 tablets if 35 kg or more. Best taken with food.
Drug resistance is a major problem with malarial treatment. Most strains of malaria are now resistant to chloroquine alone or in combination with other drugs. Paracetamol is best for reducing the fever. Make sure the patient is taking enough fluids.
Uncomplicated malaria can also be treated with oral quinine. However, there are some serious side effects of quinine, e.g. myocardial toxicity.
The dose of oral quinine is 10 mg/kg 8 hourly for 7 days PLUS clindamycin 5 mg/kg 8 hourly for 7 days or doxycycline (if over 8 years of age) 4 mg/kg immediately then 2 mg/kg daily for 7 days.
The quinine tablets are very bitter but can be crushed and taken with jam, or mashed banana.