Malaria is caused by plasmodium parasites transmitted via mosquito bites. The parasite has complex life cycles in both human and mosquito hosts. Anti-malarial drugs work by targeting different stages of the parasite's life cycle: blood schizonticides treat the blood stage in humans; causal prophylactics target liver stages; radical cure drugs act on liver parasites; and gametocytocides prevent transmission via mosquitoes. For uncomplicated malaria, first-line oral treatments are artemether-lumefantrine or quinine. For severe malaria, intravenous quinine is administered along with glucose to prevent hypoglycemia, a major problem in management.

1. Anti Malarials

3. The Life Cycle of the Malaria Parasite
• Malaria is caused by various species of plasmodia, which are carried by the female anopheles mosquito
• Sporozoites (the asexual form of the parasite) are introduced into the host by bite of the insect, and
these develop in the liver into three stages:
o Pre-erythrocytic stage: Schizonts which liberate merozoites
o Erythrocytic cycle: Merozoites infect red blood cells, forming motile trophozoites, which after
development release another batch of erythrocyte-infecting merozoites, causing fever
o Exo-erythrocytic stage: Dormant hypnozoites may liberate merozoites later
• The main malarial parasites causing tertian (every third day) malaria are:
o P. vivax, which causes benign tertian malaria
o P. falciparum, which causes malignant tertian malaria. Unlike P. vivax, this plasmodium has no
exo-erythrocytic stage
• Some merozoites develop into gametocytes, the sexual forms of the parasite.
• When the gametocytes are ingested by the mosquito, these give rise to further stages of the parasite's
life cycle within the insect.

5. Classification of Anti-Malarial Drugs according to the Malarial Activity
• Drugs used to treat the acute attack of malaria act on the parasites in the blood
(blood schizonticides).
• They can cure infections with parasites (e.g. Plasmodium falciparum) that have no
exoerythrocytic stage.
• Drugs used for chemoprophylaxis (causal prophylactics) act on merozoites emerging
from liver cells.
• Drugs used for radical cure are active against parasites in the liver.
• Drugs that act on gametocytes prevent transmission by the mosquito.

8. Treatment of Malaria
UNCOMPLICATED:
● first line drug for treatment of a patient with uncomplicated malaria is
Artemether – Lumefantrine OR Quinine tablets.

9. Severe Malaria
• Provision of appropriate treatment with intravenous Quinine
• Hypoglyceamia remains a major problem in the management of severe malaria
especially in young children and pregnant women
Administration of Intravenous Quinine • Quinine dihydrochloride 10mg salt/kg body
weight.
• Diluted in 5-10ml/kg body weight of 5% dextrose or dextrose – saline.
• Infused over 4 hours and repeated every 8 hours.
• The total volume given will depend on the patients overall fluid balance.
• The drop rate calculated as follows:
• Drop rate per minute = amount of fluid to be infused (in ml) x 20 ( drop factor) Time

10. Infusion should be discontinued as soon as the patient is able to take oral
medications.
• Oral quinine maintenance dose should be the same for the remaining days to complete
seven days treatment.
• Oral Quinine maintenance dose should be 7mg/kg body weight in patients with
impaired renal function.
• Patient should be properly instructed to complete the seven-day treatment.
• Alternatively, a full course of ALu may be administered to complete the treatment once
the need to go to oral medication has been sought.
• Where facilities for intravenous administration of Quinine are not availableI,njectable
quinine should be given by the intramuscular route of 10mg/kg body weight in dilution of
quater strength of water for injection every 8 hours until the patient is able to take oral
medication