TREATMENT OF NON-PLASMODIUM FALCIPARUM INFECTIONS In sub-Saharan Africa only 5-10 % of the malaria infections are due to one of the other Plasmodium parasites e.g. P. vivax,
P. ovale or P. malariae. Infections contracted in the Caribbean and some countries in Central America and the Middle East are mostly P. vivax. The parasite species
should be confirmed microscopically.The regimens for the treatment of other Plasmodium infections are in Table 3. CHLOROQUINE AND PRIMAQUINE
Plasmodium ovale and P. malariae
are currently chloroquine sensitive, and rare cases of chloroquine resistant P. vivax have only been documented in Oceania. Pure infections of P. malariae can be
treated with chloroquine monotherapy, while infections with P. vivax or P. ovale
should be treated with chloroquine and a follow-up course of primaquine to eradicate the residual intrahepatic phase to prevent relapses (see Table 3).20Primaquine is contra-indicated in children under 1 year of age and during pregnancy. In pregnant women eradication of the intra-hepatic stage must be delayed until
after delivery. In patients with a glucose-6-phosphate dehydrogenase (G6PD) deficiency, primaquine can be taken at 0,5 to 0,75 mg/kg body weight once every 7 days for 8 weeks.21
TREATMENT OF MIXED PLASMODIUM INFECTIONS
In patients with confirmed or suspected mixed infections, i.e. P. falciparum with P. vivax or
P. ovale, the standard therapy for uncomplicated or complicated P. falciparum malaria plus a follow-up course of primaquine is recommended. A mixed infection of
P.falciparum and P. malariae can only be treated for P. falciparum malaria. The severity of the P. falciparum
infection should dictate initial therapy. Doubt frequently exists about the presence of P. falciparum in addition to other Plasmodium
species. The patient should then be treated for P. falciparum as this is the only species associated with severe infections and complications. The guidelines are endorsed by the Medical Association of South Africa. |
