Which is the Best Antimalarial Tablet?
There are numerous antimalarial drugs used in tablet forms that are used for treatment and prophylaxis of malaria. Artemisinin derivatives like Artemether, Arteether, and Artesunate is most effective antimalarial tablets available in the present scenario. They are the first line drugs for the treatment of severe and complicated falciparum malaria. Malaria, an infectious disease, caused by the bite of a female mosquito is one of the leading causes of mortality in the world. It is now an endemic disease in many of the Sub African regions and much of Asia and America. The pattern of distribution of malaria in the tropical and subtropical region is due to invariable temperature and high – humidity throughout the year.
The main objectives of the drug therapy for Malaria are:
- To prevent clinical attack/Prophylactic.
- To treat clinical attack/Curative.
- For the eradication of the causative organism from body/Radical curative.
- To lower down the human to mosquito transmission/Gametocidal.
Drugs Used for the Treatment of Malaria
There are different classes of drugs that are being used for the treatment of Malaria. These include-
- Cinchona derivatives- Quinine, Quinidine.
- Quinolines-Chloroquine, Mefloquine, Amodiaquine, Primaquine.
- Biguanide- Proguanil.
- Amino alcohol- Halofantrine, Lumefantrine.
- Sesquiterpene lactones- Artesunate, Artemether, Arteether, Arterolane.
- Sulfonamides- Sulfadoxine, Sulfamethopyrazine, Dapsone.
- Antibiotics- Tetracycline, Doxycycline, Clindamycin.
- Treatment of Malaria depends on the severity and the type of this disease.
Malaria can be complicated or uncomplicated; the later includes Plasmodium falciparum infection accompanied by hyper parasitaemia, hyperpyrexia, cardiovascular collapse, jaundice, anemia, electrolyte imbalance.
Sesquiterpene Lactone/Artemisinin Derivatives: A Brief Discussion
The principal active compound of artemisinin drugs is artemisinin which is obtained from plant Artemisia annua, which is actually a traditional Chinese medicine. Their potent Schizontocidal action is exerted by producing quicker defervescence and parasitaemia clearance than other antimalarial Drugs.
Artemisinin has a wide range of action on all the stages of the malarial parasite cycle ranging from ring form stage to early schizonts stage thus having a wide antimalarial action.
Artemisinin-Based Combination Therapy/ACT:
The WHO, in the view of filling of the monotherapy to prevent or reduce the prevalence of Malaria globally and the development of multidrug resistance against Plasmodium falciparum, has recommended that all kisses of uncomplicated falciparum malaria must be treated by the combination therapy. The drugs to be given in the combination therapy are chosen on the basis of the half-life of the drug so that an effective concentration of drug in the body is maintained for 3 or 4 asexual cycles of the parasite.
Advantages of the ACT over Other antimalarial Drugs:
- They are widely used as the clinical and parasitological cure.
- High efficacy and high cure rates.
- The absence of parasitic resistance (although it is being seen in a few places).
- Better tolerability profile.
- Effective against multidrug-resistant Plasmodium falciparum infection.
Artemisinin is one of the most efficacious drugs for the treatment of uncomplicated and complicated malaria.
The use of these drugs are not only limited to treatment of malaria, but can also be used as antihelminthic in blood fluke and liver fluke infections.
The WHO has recommended monotherapy or multidrug therapy for the treatment of uncomplicated Malaria, but in the past relapse rate have been high. Combination therapy is highly effective against Plasmodium falciparum one drug kill majority of parasite just after the starting of treatment while another truck slowly clears parasite load.
For severe malaria, artemisinin preparations are given parenterally i.e. IV or IM. The superiority of artemisinin over Quinine can be proved as Artemisinin is associated with the reduction in the Death Rate due to malaria.
Artemisinin in Pregnancy
Malaria in pregnancy is quite dangerous for the fetus it can cause Anemia, Stillbirth, Intrauterine Death, Intrauterine Growth Retardation etc. Artemisinin-based combination therapy has been proved to be safe during pregnancy specifically in later stages of gestation. Artemisinin drugs are to be taken once or twice daily enabling the patient to take the complete course of treatment.
Adverse Drug Reactions
Artemisinin over Quinine
The side effect associated with the quinine is much higher than that of artemisinin drug.
Resistance against quinine has been developed in many of the other regions while against artemisinin is restricted to few countries only.
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