[Treatment of malaria in children: 1. Uncomplicated malaria].
Malaria is a worldwide epidemic causing high morbidity and mortality especially in children younger than 5 years. In France the incidence of pediatric malaria has constantly increased up to 1500 cases in the last two years, due to Plasmodium falciparum in more than 80% of cases. According to current recommendations, any patient with clinical suspicion or confirmed diagnosis of malaria must be hospitalized for treatment. Halofantrine is the most widely used antimalarial for treatment of uncomplicated P. falciparum malaria in children. However due to halofontrine-related cardiotoxicity some teams recommend mefloquine as the first-line drug despite disadvantages related to its poorly adapted formulation and adverse gastrointestinal effects in young children. Treatment of malaria involving other plasmodium species is still based on chloroquine. Likewise the World Health Organization continues to recommend chloroquine as the first-line agent for uncomplicated malaria in endemic zones with moderate chloroquine resistance. Amodiaquin or sulfadoxine-pyrimethamine combination may be used either in case of failure or as first-line agents in zones with high chloroquine resistance. In case of multiple resistance, quinine may be used alone or in association with an antimicrobial. Other drug therapies such as combinations using artemisinine derivatives have been shown to be highly effective for control of clinical symptoms and parasitemia. Widespread use of these therapies to prevent the appearance and extension of resistance is now undergoing evaluation.
Imbert
P
P
Service des Maladies infectieuses et Tropicales, Hôpital d'Instruction des Armées Bégin, 69, avenue de Paris, 94163 Saint-Mandé, France. hiabegin.mit@worldonline.fr
Laurent
C
C
D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D004351:Drug Resistance; D005602:France; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000188:drug therapy* / Q000473:pathology; D010963:Plasmodium falciparum / Q000187:drug effects / Q000472:pathogenicity; D010965:Plasmodium malariae / Q000187:drug effects / Q000472:pathogenicity; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D014944:World Health Organization
D000962:Antimalarials