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close this bookGuidelines for the Treatment of Malaria (WHO; 2006; 266 pages) View the PDF document
View the documentGlossary
View the documentAbbreviations
open this folder and view contents1. Introduction
View the document2. The clinical disease
open this folder and view contents3. Treatment objectives
open this folder and view contents4. Diagnosis of malaria
open this folder and view contents5. Resistance to antimalarial medicines9
open this folder and view contents6. Antimalarial treatment policy
open this folder and view contents7. Treatment of uncomplicated P. Falciparum malaria10
close this folder8. Treatment of severe falciparum malaria14
View the document8.1 Definition
View the document8.2 Treatment objectives
View the document8.3 Clinical assessment
View the document8.4 Specific antimalarial treatment
View the document8.5 Practical aspects of treatment
View the document8.6 Follow-on treatment
View the document8.7 Pre-referral treatment options16
View the document8.8 Adjunctive treatment
View the document8.9 Continuing supportive care
View the document8.10 Additional aspects of clinical management
View the document8.11 Treatment during pregnancy
View the document8.12 Management in epidemic situations
View the document8.13 Hyperparasitaemia18
open this folder and view contents9. Treatment of malaria caused by P. vivax, P. ovale or P. malariae19
View the document10. Mixed malaria infections
open this folder and view contents11. Complex emergencies and epidemics
open this folder and view contentsAnnexes
 

8.6 Follow-on treatment

Following initial parenteral treatment, once the patient can tolerate oral therapy, it is essential to continue and complete treatment with an effective oral anti-malarial. Current practice is to continue the same medicine orally as given parenterally to complete a full 7 days of treatment. In non-pregnant adults, doxycycline is added to either quinine, artesunate or artemether and should also be given for 7 days. Doxycycline is preferred to other tetracyclines because it can be given once daily, and does not accumulate in renal failure. But as treatment with doxycycline only starts when the patient has recovered sufficiently, the doxycycline course finishes after the quinine, artemether or artesunate course. Where available, clindamycin may be substituted in children and pregnant women, as doxycycline cannot be given to these groups. Although following parenteral treatment with a full course of oral ACT (artesunate + amodiaquine or artemether-lumefantrine) is theoretically a good alternative, this has not been evaluated in clinical trials.

The recommendation from experts' opinion is to complete treatment in severe malaria following parenteral drug administration by giving a full course of combination therapy, ACT or quinine + clindamycin or doxycycline. Regimens containing mefloquine should be avoided if the patient presented initially with impaired consciousness. This is because of an increased incidence of neuropsy-chiatric complications associated with mefloquine following cerebral malaria.

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