31 January 2012

Intermittent Treatment After Severe Malaria

Most of the critical illness and the majority of deaths from falciparum malaria occur in young children, and to a lesser extent in pregnant women.  When children are discharged from the hospital after treatment of severe malaria with accompanying anemia, they are at particularly high risk for re-infection.   A recent study in Lancet (1) reported a randomized controlled trial following children who were hospitalized for severe malaria and received blood transfusion.  When they were treated with standard doses of CoArtem (artemether-lumefantrine) or placebo at one and two months post discharge, the treatment group showed  a 30-40% decrease in recurrence of disease, hospital readmission, and death.  The authors and the accompanying editorial recommend that this approach be considered in areas of high seasonal rates of malaria.  Intermittent preventive treatment with CoArtem has also been used successfully in pregnant women in high risk areas, reducing both morbidity and fetal loss.  Intermittent Preventive Treatment (IPT) is a cost effective, relatively simple way to reduce both morbidity and mortality in these two high- risk groups.  IPT should be combined with other proven preventive measures such as iron supplementation and regular use of insecticide treated bed nets.
REF: (1) Steketee, et al, Targeting of Intermittent Preventive Treatment for Malaria:  Lancet Inf Diseases on line Dec 14, 2011.
Submitted by Roger Boe MD, Medical Consultant

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