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Rationale:
- Treat all cases of malaria as P. falciparum until proven otherwise, because P. falciparum infections can rapidly become life-threatening.
- Be alert for mixed species infections, especially P. vivax and P. falciparum, which have considerable geographical overlap in distribution.
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Evidence:
- High-grade resistance of P. vivax to chloroquine has been reported in Oceania and parts of Southeast Asia. One study showed that chloroquine treatment failed
in 22% of 46 subjects in Irian Jaya for P. vivax malaria (6). Another study in Indonesia showed that chloroquine treatment failed in 64% of 64 subjects with P. vivax malaria (7).
- Case reports and small series of patients with chloroquine-resistant P. vivax have also been reported from Brazil (8), Guyana (9), Colombia (10), India (11), and Myanmar (12).
- Chloroquine-resistant P. malariae has been reported in Sumatra, Indonesia. Of 28 patients followed, 2 had persistent parasitemia to day 8 of follow-up, despite
therapeutic chloroquine levels (13).
- Among 128 U.S. civilians who developed malaria after using prophylaxis recommended by the CDC, 16% had mixed infections according
to the CDC's Provisional Data Report on Malaria Surveillance and Use of Antimalarial Prophylaxis, January - December 2001.
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Comments:
- Sulfadoxine-pyrimethamine is not generally effective for the treatment of P. vivax infections.
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Harry Tagbor, MBChB, DrPH, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Rick M. Fairhurst, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Thomas E. Wellems, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Malaria
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