MALARIA

: Presented by
Dr. Emad Ibrahim Osman
Med Reg
Dr. Alafandi Unit
What is considered evidence-based medicine?
Evidence based medicine (EBM) is the
conscientious, explicit, judicious and reasonable use
of modern, best evidence in making decisions about
the care of individual patients. EBM integrates
clinical experience and patient values with the best
available research information.
W
Paracetamol
Regular doses of paracetamol have been found to be
reno-protective in patients with severe malaria. Acute
kidney injury is often a fatal complication of severe
malaria. Haemolysis is thought to be a major contributor
to acute kidney injury, and paracetamol inhibits cell-free
haemoglobin-induced lipid peroxidation. A small phase 2,
open-label, randomised controlled trial found that
paracetamol had reno-protective effects in adults with
severe falciparum malaria, particularly in participants
with prominent intravascular haemolysis. [142] It has
also been found to improve renal function in patients
with severe knowlesi malaria, particularly in participants
with acute kidney injury and haemolysis. [143] Further
research is required.
Ivermectin
Ivermectin is an anti-parasitic agent that works in
malaria by killing mosquitoes that are exposed to
the drug while feeding on the blood of people who
have ingested the drug. A Cochrane review
concluded that it is uncertain whether community
administration of ivermectin has an effect on
malaria transmission. There was no notable
difference in the presence of malaria between the
treatment and control groups (very low‐certainty
evidence). However, this was based on the only trial
published to date which included eight villages in
Burkina Faso. Several research studies are in
progress. [141]

Pyronaridine/artesunate
Pyronaridine/artesunate is a novel artemisinin-based
combination therapy (ACT) that has been approved by the
European Medicines Agency for use outside of the European
Union. It is currently available only in South Korea, where it
is indicated for the treatment of acute, uncomplicated
malaria infection caused by Plasmodium falciparum or
Plasmodium vivax in children and adults in areas of low
transmission with evidence of artemisinin resistance.
Although the drug combination has been shown to be
efficacious and well tolerated compared to current first-line
ACTs, [139] the World Health Organization do not
recommend its use as a first-line treatment, but advise that it
may be considered in areas of multiple drug resistance. [42]
A Cochrane review of five randomised controlled
trials with 5711 participants across Africa and Asia
found that pyronaridine/artesunate was as
efficacious or better than existing ACTs for
uncomplicated P falciparum malaria, with a less
than 5% failure rate at days 28 and 42. [140] [ ]
The main adverse effect associated with
pyronaridine/artesunate is hepatotoxicity, and
liver function should be monitored during
treatment.
THE END

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