Correct!
5. All of the above
The Center for Disease Control and WHO have treatment guidelines/algorithims readily available on their websites. This patient had been diagnosed with malaria and was thought to be a treatment failure due to the chloroquine resistant malaria endemic to the area of Africa in which he had traveled.
Our infectious disease colleagues as well as the CDC were contacted when this patient arrived to the hospital. The patient received an initial 600 mg infusion of quinidine over 1-2 hours followed by a 2,880 mg infusion over 24 hours. This infusion was given in conjunction with doxycycline 100 mg IV x1. This was followed by artesunic acid therapy the next day.
Artesunic acid (Figure 2) has become the second parenteral drug available for the treatment of malaria in the United States after quinidine. It belongs to a class of medications known as the artemisinins. Artemesinins are derived from the plant Artmisia annua which has long been employed as herb in traditional Chinese medicine. This medication carries a “strong recommendation” from the WHO for initial treatment in patients with severe malaria. It is available in the United States only by contacting the CDC on their hotline; it is regulated by the FDA for investigational use only in the United States.
Figure 2. The investigational drug artesunic acid for chloroquine-resistant P. falciparum.
Which of the following has been used as adjunctive treatment for severe P. falciparum malaria?
1. Inhaled nitric oxide
2. RBC transfusions
3. RBC exchange transfusion
4. Maintenance fluids only
5. All of the above