oa SA Pharmaceutical Journal - A practical guide to the management of malaria in South Africa - 2010 : review
Plasmodium falciparum accounts for the majority of malaria cases in southern Africa and may be associated with severe and fatal disease if not treated timeously. Almost all South Africans, including residents of seasonal malaria transmission areas, are non-immune and are therefore at risk for developing severe malaria. Malaria is a dynamic field and guidelines on the treatment therefore need to be updated regularly. The guidelines have recently been updated and are currently being printed.
For uncomplicated malaria, artemether-lumefantrine (Coartem®) is recommended for first line therapy. Alternatively, quinine plus either doxycycline or clindamycin can be used if artemether-lumefantrine is unavailable or contraindicated.
For severe malaria, intravenous artesunate or quinine (with the addition of doxycycline or clindamycin) is recommended. Patients with severe malaria require hospital admission. All patients with malaria require careful clinical and parasitological follow-up.
Appropriate treatment is intended to reduce morbidity and mortality, reduce malaria transmission and limit drug resistance, particularly in the light of efforts to eliminate malaria from South Africa.
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