Pharmacotherapy/Treatment Of Congenital Malaria In Neonates

Malaria is a disease spread by the anopheles mosquito. It is caused by a parasite. There are five types of parasites responsible for malaria with similar symptoms. They affect people of all ages from different geographical locations.

Congenital Malaria treatment

People in endemic areas like Nigeria can develop partial immunity to malaria. This immunity does not last for a long time. A newborn baby (neonates) born in endemic areas may acquire this partial immunity from the mother. This partial immunity can last for the first three months of life. That is why neonates don't often develop malaria.

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Malaria infection in the first few months of life may be due to transplacental transfer of parasietized maternal erythrocytes (asexual stage of the parasite). This is called congenital malaria. This was first described in 1876. It occurs during pregnancy or perinatal labour. Malaria can be transferred to the baby even when the mother did not experience any active malaria during the entire pregnancy. Due to acquiring immunity against malaria parasites in endemic areas, there is a possibility of spontaneous clearance of the parasite from the body in neonates. This could be as high as 93%. Clinical features include fever (occur in 80% of cases), anemia and splenomegaly. Others are jaundice, hepatosplenomegaly, regurgitation, loose stool and poor feeding. These symptoms can occur anytime between 10-30 days or even months after birth. It's prevalence in Nigeria is between 17.4-24.8%. It is becoming common due to drug resistance malaria parasite.

Pharmacotherapy/Treatment Of Congenital Malaria

There are several drugs and parenteral preparation for preventing and treating malaria. There are several preparations, especially vaccines, in developmental stages. All of them are indicated for babies above three months of age to adults. There are no treatment guidelines for treating malaria in neonates. This is due to the moral standards of carrying out research and development (RD) of drugs in neonates. The only treatment guidelines available to the public are currently in use report of efficacy and safety profile of off label use of malaria drugs in clinical settings. They are documented by those who are into peer review.

Infants can deteriorate rapidly when hit by malaria. Parenteral preparation is preferred for neonates. They should be on a low threshold for parenteral preparation.

In Nigeria, the most commonly used drug for treating malaria in neonates is chloroquine. Since there is no standard, there are varying reports on disease use. One report was 25mg/kg in the first dose but failed to indicate the frequency and duration. The other uses 10mg/kg at 0 hour. Then 5mg/kg at 6, 24 and 48 hours intervals with good results.

Another drug of choice is amodiaquine. Unfortunately, single unit amodiaquine is not in Nigeria. It can be found in combination with artesunate. The preparation for pediatrics comes in artesunate 25mg and amodiaquine 75mg. It is given once a day for three days. Alternatively, a 4mg/kg artesunate and 10mg/kg amodiaquine is recommended.

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The last that has been successfully reported to work with little or no side effects is sulfadoxine and pyrimethamine. It is not recommended for babies less than 6 weeks but others put it at 2 months. The dose is based on body weight. Newborn average weight is 3-5kg. 5kg babies can use a half tablet 500mg sulfadoxine and 25mg pyrimethamine. Or a 2.5ml of 500mg sulfadoxine and 25mg pyrimethamine suspension. As for neonates with less than 5kg body weight, ¼-¾ of one tablet or 1.25ml of the suspension is given.

The world health organisation (WHO) do have an insight as to what to do in neonates. They know that there is currently a lack of appropriate guidelines for treatment of malaria in neonates. Lack of infants formulation for can lead to under or over dosing. They recommend that artemisinin combination therapy (act) should be scaled down using the weight of the neonates.