Walsh & Hoyt: Treatment

The principles of clinical management of malaria are (a) early recognition of the disease; (b) rapid institution of effective antimalarial chemotherapy by appropriate routes of administration; (c) recognition of, and immediate therapy for, complications; and (d) monitoring of the immediate and long-term clinical and parasitologic responses to treatment. Early diagnosis of malaria permits immediate and aggressive medical treatment before severe complications arise. Most patients, particularly those infected with P. falciparum, are treated with quinine or one of its derivatives, such as chloroquine or mefloquine. However, chloroquine-resistant P. falciparum, and even multidrug-resistant malaria, is an increasing concern throughout the world. Fortunately, other drugs are also available, such as halofantrine, phenanthrene-methanol, pyrimethamine-sulfadoxine, pyronaridine, azithromycin, atovaquone and a group of drugs called the artemisinin compounds. These latter drugs are derived from the Chinese medicinal herb called qing hao, which is obtained from the plant Artemisia annua. This plant, also known as annual or sweet wormwood, is widely distributed in Europe, North America, India, and Eastern Asia. Qing hao has been used to treat a variety of febrile illnesses in China for almost 2000 years. In 1972, Chinese scientists isolated seven compounds from indigenous species of A. annua. One of these compounds, a previously unknown crystalline substance, was found to have significant antimalarial properties and was named ""qinghaosu"" after the original medicinal herb. Qinghaosu, also called artemisinin, and several of its derivatives clear parasitemia more rapidly than other drugs in both mild and severe malaria.