Unwanted side effects: the problems of antimalarials

A malaria rapid diagnostic test  being deployed A malaria rapid diagnostic test being deployed
09 Dec
A rapid malaria test has stemmed overuse of antimalarials, but is risking the overuse of antibiotics instead

One of the main symptoms of malaria is fever. Before 2010, the World Health Organization recommended that patients with fevers in susceptible countries receive antimalarial drugs whenever possible. The drawback was that overusing antimalarial drugs could also increase the disease’s resistance, could waste resources, and could also fail to address other causes of the fever.

Enter malaria rapid diagnostic tests (mRDTs) – small, reliable tools that enable accurate diagnosis in the most remote environments. ‘Over the last decade, mRDTs have become essential for malaria control,’ says Heidi Hopkins, associate professor in malaria and diagnostics at the London School of Hygiene and Tropical Medicine. She has analysed the test’s impact on fever treatment and points out that half of children treated for fever in 22 malaria-prone countries were tested for the disease in 2015.

‘It’s great news if you’re looking at better targeting of malaria medicine,’ she says. ‘The drawback is that the mRDT can only rule out malaria.’ Unfortunately, fever is also a symptom of serious bacterial infections such as sepsis and meningitis, which require a course of antibiotics. ‘In these settings, there is no way to differentiate between a bacterial infection and a self-improving fever that only needs mild treatment with ibuprofen or paracetamol.’

By compiling the data of over 500,000 patients from ten countries in Asia and sub-Saharan Africa, Hopkins found that 40 to 80 per cent of those who tested negative for malaria were prescribed antibiotics instead, despite those who need them likely being much lower than 40 per cent. In other words, overuse of antimalarial medicine has been traded in for presumptive use of antibiotics.

‘We can understand the likely reasons for this – in many cases, patients travel many miles to reach a clinic, and health workers just want to be able to treat them in some manner,’ says Hopkins.

Overuse of antibiotics is thought to be a major factor in the global rise of antibiotic-resistant infections. Such resistance is described as ‘a global health emergency that will seriously jeopardise progress in modern medicine,’ by Tedros Adhanom, director-general of WHO. Because fever is the symptom shared by so many different kinds of illnesses, Hopkins is advising researchers gain a ‘much more thorough understanding of its causes in different settings, and how to differentiate between them.’

This was published in the December 2017 edition of Geographical magazine.

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