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Microbiology · Parasitology: severe falciparum malaria
Sample itemA 35-year-old man with Plasmodium falciparum malaria is drowsy, with a Glasgow Coma Scale score of 10 and 8% parasitaemia. Which regimen is appropriate?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Intravenous artesunate followed by a full course of oral artemisinin combination therapy
Severe malaria needs parenteral artesunate, which clears parasites faster and lowers mortality compared with quinine. Once the patient can take oral medication, a full course of an artemisinin combination is completed, and glucose is monitored. In India, intramuscular artemether or intravenous quinine are alternatives when artesunate is unavailable.
Option by option
A. Intravenous artesunate followed by a full course of oral artemisinin combination therapy (correct)
Correct. IV artesunate followed by an oral ACT is the recommended treatment.
B. Oral artemether-lumefantrine alone
Oral artemether-lumefantrine is suited to uncomplicated malaria and absorption is unreliable in severe disease.
C. Single-dose oral primaquine alone
Primaquine is a gametocidal drug and has no role in treating severe asexual infection.
D. Oral chloroquine for 3 days
Oral chloroquine is unreliable because of widespread falciparum resistance and cannot be given orally to a drowsy patient.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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