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7. Treatment of uncomplicated P. falciparum malaria

should be used if core temperatures > 38.5 oC. Paracetamol (acetaminophen) 15 mg/kg
every 4 hours is widely used; it is safe and well tolerated, given orally or as a suppository.
Ibuprofen (5 mg/kg) has been used successfully as an alternative in malaria and other
childhood fevers, although there is less experience with this compound. Acetylsalicylic
acid (aspirin) should not be used in children because of the risks of Reye’s syndrome.

7.7.3 Use of antiemetics

Vomiting is common in acute malaria and may be severe. Antiemetics are widely used.
There have been no studies of their efficacy in patients with malaria, and no comparisons
between different antiemetic compounds; there is no evidence that they are harmful
though they can mask severe malaria. Patients that vomit everything, including the
medicines, should be managed as severe malaria (see Sections 8.4–8.7).

7.7.4 Management of seizures

Generalized seizures are more common in children with P. falciparum malaria than in
those with the other malarias. This suggests an overlap between the cerebral pathology
resulting from malaria and febrile convulsions. As seizures may be a prodrome of
cerebral malaria, patients with repeated seizures (more than two seizures within a
24 h period) should be treated as for severe malaria (see Sections 8.4–8.7). If the seizure
is ongoing, the airway should be maintained and anticonvulsants given (parenteral or
rectal benzodiazepines or intramuscular paraldehyde). If it has stopped, the child should
be treated as indicated in Section 7.7.2, if core temperature is above 38.5 oC. There is no
evidence that prophylactic anticonvulsants are beneficial in otherwise uncomplicated
malaria, and they are not recommended.

7.8 operational issues in treatment management

Individual patients derive the maximum benefit from ACTs, if they can access these
within 24–48 hours of the onset of malaria symptoms. At a population level, their impact
in terms of reducing transmission and delaying resistance depends on high coverage rates.
Thus, to optimize the benefit of deploying ACTs, their deployment should target the public
health delivery system, the private sector and the community or household. It should
also ensure that there is no financial or physical barrier to universal access. The strategy
to secure full access (including home-based management of malaria) must be based on
an analysis of the national and local health systems, and this may require legislative
change and regulatory approval with additional local adjustment based on programme
monitoring and operational research. The dissemination of national treatment guidelines
with clear recommendations, production and use of appropriate information, education
and communication materials, monitoring both of the deployment process, access and
coverage, and provision of adequately packaged (user-friendly) antimalarials are needed
to optimize the benefits of providing effective treatments widely.
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