#Chloroquine and Malaria treatment options- in pregnancy & for visitors

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Get started here on basic malaria 101 in Nigeria.

There is a fundamental need to always conduct a test before treating malaria.

*The officially recommended Anti-Malarial Drugs: ACTs

Globally, the first line treatment option is clearly the currently WHO recommended anti-malarial drugs, the Artemesinin Combination Therapy (ACTs). The two ACTs recommended for use in Nigeria are: Artemether-Lumefantrine and Artesunate- Amodiaquine combinations.  These medications have properties that can effectively clear malaria parasites in the blood stream.

Indeed, Monotherapy with dihydroartemisinin, other artemisinin derivatives and other antimalarial drugs (including Chloroquine and sulphadoxine-pyremethamine – sold under any brand name) are not recommended in Nigeria’s malaria diagnosis and treatment policy. There have been rigorous therapeutic efficacy trials on our recommended ACTs with overwhelming evidence based results affirming their effectiveness.

The vital issue of high quality malaria testing comes into play before any arguments may be made on the efficacy of ACTs. The need to conduct a test before treating malaria is so important and the increasingly widespread availability of Rapid Diagnostic Test (RDT) kits should facilitate this. Not only will this practice reduce over-diagnosis and over-treatment of malaria, it will also avert the danger of glossing over other life-threatening conditions may have otherwise been missed.

*Malaria Treatment Options

For Severe Malaria- Other current best practices on malaria case management include the use of intramuscular Artesunate, Rectal Artesunate and intramuscular Quinine for pre-referral treatment. In complicated malaria such as where the patient is in a coma, treatment should be with intravenous or intramuscular routes of Artesunate and Quinine Dihydrochloride; and it is recommended that treatment should be completed with full course of ACTs once patient can take medications orally to achieve complete cure.

For Malaria in pregnancy- The use of oral Quinine at all trimesters is recommended.  ACTs should be used at the second and third trimesters but it can be used in the first trimester where Quinine is not accessible.

For Chemoprohylaxis for Non-Immune Visitors- Atovaquone-Proguanil (Malarone) and Mefloquine are the choice drugs. In addition, use mosquito control measures such as consistently sleeping in long lasting insecticide treated nets (LLINs), use of indoor residual sprays (application of malaria insecticide on the walls inside the house), clearing of the surrounding of materials such as used tyres, cups, plant materials etc that could provide a breeding ground for the mosquitoes among other strategy.

PREVENTING MALARIA

DEMYSTIFYING THE CHLOROQUINE MAGIC

Unlike these ACTs which only possess anti-parasitic of clearing the blood stream of the malaria parasites, chloroquine has an additional anti-pyretic effect; that means chloroquine has the ability to directly reduce fever.

Unfortunately, it is a proven fact that malaria parasites are now resistant to chlororquine.

The implication is that individual (sadly, including some health managers) who still use chloroquine tout about their “better” outcome because of this associated fast fever relief. These practices abound in areas where parasite-based diagnosis is not done or not accessible.

In reality, the feverish symptom itself should and can be taken care of by any regular over the counter paracetamol product. Proper treatment to eradicate malaria from the blood stream has to be with the recommended ACTs, in combination with an anti-pyretic like paracetamol for symptomatic relief.

MALARIA TREATMENT WITH CHLOROQUINE IS NOW OBSOLETE! 

Seriously, what is FEVER?

*Culled from the National Guidelines for Diagnosis and Treatment of Malaria, Federal Ministry of Health, National Malaria and Vector Control Division, Abuja-Nigeria, March 2011.

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