Hello, I’m wondering if I should be worried about whether my malaria will come back or not. I came down with Falciparum in the US and was treated with malarone pills (four pills a day for three days); was ill enough to be hospitalized, but did not have severe malaria. About a week and a half after finishing the treatment (and two days after returning to a malaria-endemic country) I started getting body pains. After two days, I went and tested, but was negative for malaria, while positive for a mild bacterial infection, and was started on a five-day course of an oral antibiotic and NSAIDs for the pain. On day four, I started having a headache and no appetite; I tested the next morning with Falciparum. The doc said the malarone probably didn’t clear it all out of my system, not a new infection as I had only recently arrived back in country. I was taken off the NSAIDs and oral antibiotic and was given injections of artemether for three days plus ceftriaxione. I’ve now tested negative for malaria (blood-slide test). My question is, how concerned should I be about this infection re-occurring, especially as artemether is not an ACT? And should I go to this clinic if I get malaria again, or demand an ACT (I also don’t want to add to artemisin drug resistance in the world)? It’s one of the best clinics available here, unfortunately, so not a lot of options. I’m guessing that I would have been treated with Coartem pills if I hadn’t just had an infection, but I don’t know why they didn’t switch me to oral pills after the first injection, unless it was because I was having gastritis (due to the various painkillers, antibiotics and anti-malarials in this three week course of events). Also, why would malarone be used instead of an ACT, as happened the first time I was treated? Thanks for answering!
Answer: Thanks for the question! Starting from the end, I suspect you would have been given malarone because for whatever reason, the clinic you went to in the US did not have quick access to ACTs. Certainly you should have received ACTs if they had been available, as ACTs are the WHO-recommended first-line medication for uncomplicated falciparum malaria. Unfortunately, due to the paucity of malaria cases seen by most doctors in the US, it’s also possible that the doctor you saw was unfamiliar with the most recent WHO guidelines and since s/he had ready access to malarone, thought it would be good enough. As it sounds like you live in a malaria-endemic country, I am assuming you were not taking malaria chemoprophylaxis? If you had been taking malarone as prophylaxis, then you really should not have been given it as treatment, and it could definitely explain why the treatment was no successful. I am a bit surprised, however, that you were given injectable artemether when you got back. Injectable artemisinin-based treatments are usually only recommended for severe/complicated malaria, when oral treatment cannot be tolerated. Perhaps, as you note, the doctor felt your gastritis might have been a contraindication for taking additional pills. However, more fundamentally, the first-line injectable treatment for malaria should be artesunate, with intramuscular arthemether only given when artesunate is not available. If you get malaria again, assuming it is not a severe case and you can tolerate taking pills, I would ask for ACTs. Completing a full course of an approved ACT is your best bet for treating uncomplicated falciparum malaria.