Problem |
Drug/s |
Differentiation from severe malaria |
Treatment |
Vomiting |
Chloroquine,
Quinine,
Mefloquine,
Halofantrine,
Tetracyclines,
Primaquine |
Vomiting
is even otherwise common in malaria, usually at the height of fever. |
Anti
emetics like Domperidone and Metaclopramide. In the young, metaclopramide can cause extra-
pyramidal signs, so Promethazine can be tried. |
Dizziness |
Chloroquine,
Quinine,
Mefloquine,
Halofantrine |
Could
be due to high fever, dehydration and postural hypotension. |
Usually
mild; if bothersome, drugs like Cinnarazine, Betahistine etc. can be used |
Itching |
Chloroquine |
|
Anti
histamines can be tried |
Pain abdomen
Drug induced gastritis causes mild discomfort and very rarely abdominal cramps |
Chloroquine,
Quinine,
Mefloquine,
Primaquine |
In
malaria, particularly falciparum, there may be acute pain over upper abdomen or right
lower abdomen, mimicking acute abdominal syndromes. |
Drug
induced pain can be managed with antacids or H2 receptor blockers. |
Altered behaviour, confusion, delirium, hallucinations, etc.
Drug induced alterations in behaviour and changes in the level of consciousness usually
appear after 24-48 hours of starting treatment. By then the fever and parasitemia may be
lower. And this can occur on treatment for any type of malaria. |
Chloroquine,
Quinine,
Mefloquine |
These
symptoms can be due to severe falciparum infection or due to high grade fever in any type
of malaria. If these problems are caused by severe infection, then peripheral blood should
show falciparum infection, high degree of parasitemia and the patient may have other
symptoms and signs of severe malaria viz. anemia, hyperpyrexia, jaundice etc. |
Watchful
expectancy; if needed, tranquilizers like Haloperidol can be used. |
Convulsions
Some antimalarials can induce convulsions. It may also be due to hypoglycemia induced by
quinine. |
Chloroquine,
Quinine,
Mefloquine |
In
severe malaria, convulsions may be recurrent and may lead to unarousable coma. |
Anticonvulsants
like phenobarbitone for recurrent convulsions. Mefloquine is better avoided in known
epileptics. |
Coma |
Quinine
can cause hypoglycemia, which may present as coma. |
In
cerebral malaria, coma persists even after infusion of 50% dextrose |
25-50%
dextrose, 50-100 ml intravenously |
Hypoglycemia |
Quinine |
In
severe falciparum malaria, especially in pregnancy and children, hypoglycemia can occur
even without quinine therapy |
25-50%
dextrose, 50-100 ml intravenously |
Anemia |
Primaquine:
It can cause massive hemolysis in patients with Glucose 6-phosphate dehydrogenase
deficiency |
Anemia
is a common feature in malaria, especially in children. |
Usually
self-limiting; withdraw the drug; blood or packed cell transfusion if needed. |
Jaundice |
Primaquine
may cause hemolytic jaundice in patients with Glucose 6-phosphate dehydrogenase deficiency |
Severe
malaria can cause hemolytic jaundice, or rarely malarial hepatitis |
Withdraw
the drug |
Hemoglobinuria |
Primaquine
(same group as above) |
|
|
Fever
Continuing even after improvement in general condition and significant reduction in
parasitemia. |
Artemisinin
derivatives |
In
cases of resistant malaria, with the continuation of fever, the general condition
deteriorates and parasitemia increases. |
Self-limiting,
disappears after the drug is stopped. |
