Kevin S. Griffith, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a review of medical literature from 1966 to 2006 to provide clinicians with recommendations for diagnosing and treating malaria in the U.S. With an increasing number of U.S. residents traveling to regions in the world with high levels of malaria, there continues to be a need for treatment of this disease in the United States, with there being an annual average of 1,200 cases reported, almost all imported, resulting in up to 13 deaths per year.
The researchers write: "Important measures to reduce morbidity and mortality from malaria in the United States include the following: obtaining a travel history, considering malaria in the differential diagnosis of fever based on the travel history, and prompt and accurate diagnosis and treatment. Chloroquine remains the treatment of choice for Plasmodium falciparum acquired in areas without chloroquine-resistant strains. In areas with chloroquine resistance, a combination of atovaquone and proguanil or quinine plus tetracycline or doxycycline or clindamycin are the best treatment options."
The authors add that chloroquine remains the treatment of choice for all other malaria species, with the exception of P vivax acquired in Indonesia or Papua New Guinea, in which case atovaquone-proguanil is best, with mefloquine or quinine plus tetracycline or doxycycline as alternatives. "Quinidine is currently the recommended treatment for severe malaria in the United States because the artemisinins are not yet available."
(JAMA. 2007;297:2264-2277. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
To contact corresponding author Monica E. Parise, M.D., call Tom Skinner (404-639-7851).