ANTIMALARIAL TREATMENT AND

PROPHYLAXIS
 ANTIMALARIAL DRUGS:
THERAPEUTIC CLASSIFICATION
CASUAL Primary tissue schizonticides Proguanil
PROPHYLAXIS Liver Primaquine

SUPPRESSIVE Erythrocytic phase Chloroquine

PROPHYLAXIS Proguanil
Mefloquine
Doxycycline
ClINICAL CURE Erythrocytic schizonticides Fast acting:
Chloroquine, Quinine, Mefloquine,
Atovaquone, Artemesinin
Slow acting
Proguanil, Pyrimethamine,
Sulfonamides, tetracyclines
RADICAL Suppressive drugs + Primaquine
CURATIVES Hypnozoitocidal
GAMETOCIDAL Destroy gametocytes All species: Primaquine, artemisinin
P.vivax: Chloroquine, Quinine
Prevent development of sporozoites:
Proguanil, Pyrimethamine
CHEMICAL GROUPS AND MECHANISM OF ACTION
4 aminoquinolines Chloroquine, Inhibit conversion of heme to
Hydroxychloroquine, hemozoin
Amodiaquine, Pyronaridine
8 aminoquinolines Primaquine, Tafenoquine, Reactive oxygen species interferes
Bulaquine with O2 transport
Chinchona alkaloids Quinine, Quinidine Inhibit conversion of heme to
hemozoin

Quinoline methanol Mefloquine, halofantrine, Inhibit conversion of heme to

lumefantrine hemozoin

Biguanides Proguanil, Chlorproguanil Dihydrofolate reductase inhibitor

Diamimopyrimidines Pyrimethamine Inhibit folate biosynthesis
Sulfonamides Sulfadoxine, Dapsone
Tetracyclines Tetracycline, Doxycycline Inhibit protein synthesis
Naphthoquinones Atovaquone Interferes with cytochrome
electron transport in Mitochondria
Sesquiterpene Artesunate, Artemether, Generation of free radicals
lactones Arteether
 ERYTHROCYTIC EXO GAMETOCYTIC HYPOZOITIC
ERYTHROCYTIC
Chloroquine P.vivax, ovale, No effect P.Vivax, malariae
malariae (no falciparum)
Sensitive
p.falciparum

Quinine All Moderate activity Vivax, malaraie

Primaquine Vivax: weak P.vivax, ovale All plasmodia Vivax, malariae
Falcuparum: no including
P.Falciparum

Mefloquine All (Drug resistant

falciparum)
Atovaquone P.Falciparum and
others
Tetracycline Slow /potent P.Falciparum
Artemesinin All Species All species
Sulfadoxine/ All Species Vivax, malariae
Pyrimethamine
Proguanil Slow acting(used P.falciparum
in combination)
PREVENTION IN TRAVELLERS
 Intermittent preventive treatment during
pregnancy 
• In Malaria endemic areas of Africa
• The WHO advises
– administration of at least three doses of sulfadoxine-
pyrimethamine (SP) for IPTp,
– Sulfadoxine 500 mg +pyrimethamine 25 mg , 3
tablets once.
– ideally at each of three antenatal care visits in the
second and third trimesters
• (per WHO guidance, these antenatal visits should occur at
24 to 26 weeks, 32 weeks, and 36 to 38 weeks of gestation)
Oral regimens for treatment of Plasmodium
falciparum malaria in pregnant women