Correct use of anti-malarials to counter Plasmodium falciparum resistance
The rise of anti-malarial resistant Plasmodium falciparum in areas where malaria is endemic, such as Southeast Asia, calls for the safe and right use of current antimalarials.
In P. falciparum, resistance had been observed in all currently used antimalarials, which includes chloroquine, amodiaquine, mefloquine, quinine and sulfadoxine-pyrimethamine. As such, the WHO guidelines now recommend the use of artemisinin-based combination therapies (ACT) instead. However, recent years has seen an increase in P. falciparum resistance to ACT. This is a problem that needs to be addressed quickly as there is a limited number of antimalarials available. To put a stop to the rise in resistance, doctors can play a role by ensuring proper prescription of antimalarials. Proper prescription includes the right medication, dose and duration of treatment. At the same time, patients have to play their part in being compliant. [WHO. Guidelines for the treatment of malaria. Third edition. Available at: www.who.int/malaria/publications/atoz/9789241549127/en/ Accessed on 16 Dec]
Local guideline recommend the use of ACT for 3 days to treat uncomplicated P. falciparum infections. An alternative is to prescribe oral quinine plus oral doxycycline for 7 days. It is important to note that monotherapy is not recommended for the treatment of malaria as it will lead to increased plasmodium resistance. In severe P. falciparum infections, artesunate should be given together with doxycycline. The alternative is to prescribe quinine plus doxycycline. [MOH. Management guidelines of malaria in Malaysia. Available at: www.moh.gov.my/index.php/pages/view/118 Accessed on 16 Dec]
In locations where P. falciparum is resistant to commonly used antimalarials, the combination of quinine and doxycycline has been shown to be effective and well-tolerated. [Malar J 2015;14:445] Despite not being recommended for younger children and pregnant women, there are rarely any severe adverse effects reported in the two groups when treated with doxycycline. Another advantage of this medication is there is rarely any resistance to it. In cases of treatment failures with doxycycline, the cause has been linked to inadequate doses and poor patient compliance. Besides being an effective treatment for malaria when used in combination with other antimalarials, doxycycline is also an effective chemoprophylaxis that kills the malaria parasite in its erythrocytic stage.