The Indigenous tribes of the New World taught the Spanish Jesuit missionaries about a medicinal bark used for the treatment of fevers. The bark from the tree was called the Peruvian bark and the tree was named Cinchona after the Countess of Chinchon for whom it cured. The medicine from the bark is now known as the antimalarial, quinine.
After the diagnosis of malaria has been made, treatment should be guided by three main factors:
- The infecting Plasmodium species: P. falciparum and P. knowlesi infections can cause rapidly progressive severe illness or death while the other species are less likely to cause severe manifestations. Plasmodium vivax and P. ovale also require treatment for the hypnozoite forms that remain dormant in the liver. Plasmodium falciparum and P. vivax species have different drug resistance patterns in differing geographic regions.
- The clinical status of the patient: patients are categorized as either having uncomplicated or severe malaria. Those with uncomplicated malaria can be effectively treated with oral antimalarials. Those who have one or more symptoms (such as impaired consciousness/coma, severe normocytic anemia (Hgb <7), acute kidney injury, ARDS, hypotension, DIC, spontaneous bleeding, acidosis, hemoglobinuria, jaundice, repeated generalized convulsions, and/or parasitemia of ≥5%) are considered to have severe disease and should be treated aggressively with parenteral antimalarial therapy.
- The drug susceptibility of the parasites as determined by the geographic area where the infection was acquired and the previous use of antimalarial medicines: knowledge of the geographic area where the infection was acquired provides information on the likelihood of drug resistance and helps guide clinicians on appropriate treatment.
