Malaria Treatment with A-3

Malaria Treatment Propositions for Development Workers

Before you treat patients, please read the notes below.

  1. Pregnant women in the first Trimester:
    Until recently the WHO advised against the use of artemisinin derivates during the first trimester. Only quinine (20 mg per kg bodyweight per day for 7 days) was recommended. In the latest edition (2010) of “Guidelines for the Treatment of Malaria”, the WHO has changed its stance; “However, weighing these risks against the evidence that artesunate reduces the risk of death from severe malaria, both artesunate and quinine may be considered as options until more evidence becomes available. Treatment must not be delayed…”. In the light of both this statement and the feedback we have received from our co-workers, we feel that, with the agreement of your doctor, we can recommend the use of artemisia tea to treat malaria even in the first trimester – but not in the first week of pregnancy. Drink also 2 litres of lemon grass tea every day.
  2. Pregnant women in the second or third Trimester:
    If there is a doctor, ask his advice. You may use "anamed artemisia tea" (see below): Drink one litre each day for at least 7 days. Also drink 2 litres of lemon grass tea every day.  If necessary, you may add quinine tablets (20 mg quinine base per kg bodyweight per day for 7 days).
  3. Breast feeding mothers
    You may use "anamed artemisia tea" (see below):  Drink one litre each day for at least 7 days. Also drink 2 litres of lemon grass tea every day. If necessary, you may add quinine tablets (20 mg per kg bodyweight per day for 7 days), or three tablets of sulfa-pyri* .
    If the patient is unable to drink, try the following: Pour 500 ml of water over 10 g of dried or 50 g of fresh leaves, wait for at least 15 minutes, filter, and give as an enema (in 4 or more portions). In case of need, you may dissolve quinine tablets or syrup in this artemisia-enema: Dissolve 20 mg of quinine base per kg of bodyweight in the 500ml of enema liquid. Give this enema for seven days, or until the patient can drink again, when the medicine should be given as tea.
  4. Children 2-3 months old (or bodyweight up to 6 kg)
    Give a quarter of a sulfa-pyri* tablet once, or a total dose of 150 mg chloroquine base divided over 3 days, or a total dose of 150 mg amodiaquine base divided over 3 days. Give the child plenty to drink (boiled water, breast milk...).

    If these drugs are either not available or not effective, then use artemisia. If the baby is willing to drink the tea, administer 25 ml of "anamed artemisia tea" (see below), 4 times daily, i.e. in total 100 ml per day, for at least 7 days. Most probably, the baby will more readily take "anamed artemisia sugar" (see below): Give half a level teaspoonful 4 times daily, i.e. a daily total of 2 teaspoonfuls.

    If the baby is unconscious, try the following: Take quinine syrup , or dissolve quinine tablets (20 mg quinine base per kg bodyweight per day) in 50 ml of water, divide into 4 or more parts and give this as an enema during the day. Stop the enema as soon the patient regains consciousness, then give the necessary medicine by mouth.

    If quinine is not available, you may try artemisia-enema: Pour 50 ml of boiling water over 1 g of dried or 5 g of fresh leaves, wait for at least 15 minutes, filter, and allow to cool. Administer this tea as an enema, divided into 4 or more doses, in the course of the day. Repeat this procedure for seven days, or until the patient can drink again. In the meantime, buy the other medicine because artemisia alone may be not enough for this baby.
  5. Children 4-11 months old (or bodyweight up to 10 kg)
    Give half of a sulfa-pyri* tablet once, or a total dose of 250 mg chloroquine base divided over 3 days, or a dose of 250 mg amodiaquine base divided over 3 days. Give the child plenty to drink (boiled water, breast milk...).

    If these drugs are either not available or not effective, then use artemisia. If the baby is willing to drink the tea, administer 50 ml of "anamed artemisia tea" (see below), 4 times daily, i.e. in total 200 ml per day, for at least 7 days. Most probably, the baby will more readily take "anamed artemisia sugar" (see below): Give a level teaspoonful 4 times daily, i.e. a daily total of 4 teaspoonfuls.

    If the baby is unconscious, try the following: Take quinine syrup , or dissolve quinine tablets (20 mg quinine base per kg bodyweight per day) in 50 ml of water, divide into 4 or more parts and give this as an enema during the day. Stop the enema as soon the patient regains consciousness, then give the necessary medicine by mouth.

    If quinine is not available, you may try artemisia-enema: Pour 100 ml of boiling water over 2 g of dried or 10 g of fresh leaves, wait for at least 15 minutes, filter, and allow to cool. Administer this tea as an enema, divided into 4 or more doses, in the course of the day. Repeat this procedure for seven days, or until the patient can drink again. In the meantime, buy the other medicine because artemisia alone may be not enough for this baby.

    For this age group, Artemisia annua may also be combined with proguanil or cotrimoxazol.
  6. Children 1-2 years old (or bodyweight up to 14 kg)
    If the child is willing to drink the tea, administer 75 ml of "anamed artemisia tea" (see below), 4 times daily, i.e. in total 300 ml per day, for at least 7 days. Most probably the child will more readily take "anamed artemisia sugar" (see below): Give a level teaspoonful 5 times daily, i.e. a daily total of 5 teaspoonfuls, for at least 7 days.

    To be safe, add three-quarters of a sulfa-pyri* tablet once, or a total dose of 350 mg of chloroquine base divided over 3 days, or a total dose of 350 mg of amodiaquine base divided over 3 days. Give plenty to drink (lemon grass tea, cool, boiled water...)

    If the patient is unconscious, try the following: Pour 150 ml of boiling water over 3 g of dried or 15 g of fresh artemisia leaves, wait for at least 15 minutes, filter and allow to cool. Add quinine tablets or quinine syrup (20 mg quinine base per kg bodyweight). Give as an enema, divided into 4 or more doses in the course of the day. Repeat this enema for seven days. As soon the patient can drink again, give all the medicine by mouth.

    For this age group, Artemisia annua may also be combined with proguanil, cotrimoxazol or Malarone.
  7. Children 3-4 years old (or bodyweight up to 18 kg)
    If the child is willing to drink the tea, administer 100 ml of "anamed artemisia tea" (see below), 4 times daily, i.e. in total 400 ml per day, for at least 7 days. Most probably the child will more readily take "anamed artemisia sugar" (see below): Give 2 level teaspoonfuls 4 times daily, i.e. a daily total of 8 teaspoonfuls, for at least 7 days.

    To be safe, add one sulfa-pyri* tablet once, or a total dose of 450 mg of chloroquine base divided over 3 days, or a total dose of 450 mg of amodiaquine base divided over 3 days. Give plenty to drink (lemon grass tea, water...).

    If the patient is unconscious, try the following: Pour 200 ml of boiling water over 4 g of dried or 20 g of fresh artemisia leaves, wait for at least 15 minutes, filter and allow to cool. Add quinine tablets or quinine syrup (20 mg quinine base per kg bodyweight). Give as an enema, divided into 4 or more doses in the course of the day. Repeat this enema for seven days. As soon the patient can drink again, give all the medicine by mouth.

    For this age group, Artemisia annua can also be combined with proguanil, cotrimoxazol or Malarone.
  8. Children 5-9 years old (or bodyweight up to 29 kg)
    You may use artemisia: Pour 600 ml of boiling water over 3 g of dried artemisia leaves (or over 15 g of fresh artemisia leaves). Wait at least 15 minutes, then filter, divide into 4 cups and give one cup 4 times a day. Repeat this procedure for at least 7 days. If the child refuses to drink this tea, it will more readily accept "anamed artemisia sugar" (see below): Give two level teaspoonfuls 5 times daily, i.e. 10 teaspoonfuls in total, for at least 7 days.

    If this treatment alone is not effective enough, add one and a half sulfa-pyri* tablets once, or a total dose of 700 mg of chloroquine base divided over 3 days, or a total dose of 700 mg of amodiaquine base divided over 3 days. Give plenty to drink (lemon grass tea, water...)

    If the patient is unconscious, try the following: Pour 300 ml of boiling water over 6 g of dried or 30 g of fresh leaves, wait for at least 15 minutes, filter and allow to cool. Give as an enema, divided into 4 or more doses during the day. In case of need, you may dissolve quinine tablets (or quinine syrup) in this artemisia-enema (20 mg quinine base per kg bodyweight per day). Repeat this enema for seven days. As soon the patient can drink again, give all medicine by mouth.

    For this age group, Artemisia annua can also be combined with proguanil, cotrimoxazol, Malarone or primaquin.
  9. Children 10-11 years old (or bodyweight up to 39 kg)
    You may use artemisia: Pour 700 ml of boiling water over 3,5g of dried artemisia leaves (or over 17 g of fresh artemisia leaves). Wait at least 15 minutes, then filter, divide into 4 cups and give one cup 4 times a day. Repeat this procedure for at least 7 days. If this treatment alone is not effective, add two sulfa-pyri* tablets once, or a total dose of 900 mg of chloroquine base divided over 3 days, or a total dose of 900 mg of amodiaquine base divided over 3 days. Give plenty to drink (lemon grass tea, water...).

    If the patient is unconscious, try the following: Pour 350 ml of boiling water over 7 g of dried or 35 g of fresh leaves, wait for at least 15 minutes, filter and allow to cool. Give as an enema, divided into 4 or more doses during the day. In case of need, you may dissolve quinine tablets (or quinine syrup) in this artemisia-enema (20 mg quinine base per kg bodyweight per day). Repeat this enema for seven days. As soon the patient can drink again, give all medicine by mouth.

    For this age group, Artemisia annua can also be combined with proguanil, cotrimoxazol, Malarone, primaquin, doxycyclin or tetracyclin.
  10. Children 12-13 years old (or bodyweight up to 49 kg)
    You may use artemisia: Pour 800 ml of boiling water over 4g of dried artemisia leaves (or over 20 g of fresh artemisia leaves). Wait at least 15 minutes, then filter, divide into 4 cups and give one cup 4 times a day. Repeat this procedure for at least 7 days. If this treatment alone is not effective, add two and a half sulfa-pyri* tablets once, or a total dose of 1200 mg of chloroquine base divided over 3 days, or a total dose of 1200 mg of amodiaquine base divided over 3 days. Give plenty to drink (lemon grass tea, water...).

    If the patient is unconscious, try the following: Pour 400 ml of boiling water over 8 g of dried or 40 g of fresh leaves, wait for at least 15 minutes, filter and allow to cool. Give as an enema, divided into 4 or more doses during the day. In case of need, you may dissolve quinine tablets (or quinine syrup) in this artemisia-enema (20 mg quinine base per kg bodyweight per day). Repeat this enema for seven days. As soon the patient can drink again, give all medicine by mouth.

    For this age group, Artemisia annua can also be combined with proguanil, cotrimoxazol, Malarone, primaquin, doxycyclin or tetracyclin.
  11. Children more than 13 years old and adults (bodyweight more than 50 kg)
    You may use artemisia: Pour 1 litre of boiling water over 5 g of dried artemisia leaves (or over 25 g of fresh artemisia leaves). Wait at least 15 minutes, then filter, divide into 4 cups and give one cup 4 times a day. Repeat this procedure for at least 7 days. If this treatment alone is not effective, add 3 sulfa-pyri* tablets once, or a total dose of 1500 mg of chloroquine base divided over 3 days, or a total dose of 1500 mg of amodiaquine base divided over 3 days. Give plenty to drink (lemon grass tea, water...).

    If the patient is unconscious, try the following: Pour 500 ml of boiling water over 10 g of dried or 50 g of fresh leaves, wait for at least 15 minutes, filter and allow to cool. Give as an enema, divided into 4 or more doses during the day. In case of need, you may dissolve quinine tablets (or quinine syrup) in this artemisia-enema (20 mg quinine base per kg bodyweight per day). Repeat this enema for seven days. As soon the patient can drink again, give all medicine by mouth.

    For this age group, Artemisia annua can also be combined with proguanil, cotrimoxazol, Malarone, primaquin, doxycyclin or tetracyclin.

    * sulfa-pyri is short for sulfadoxin - pyrimethamine, trade name Fansidar.

Notes

A. These recommendations are the result of our own observational studies and studies of the literature. The WHO promotes "traditional medicine", but rarely recommends specific recipes. You are, therefore, asked to seek the support of your health authority before you use these recipes.

B. These recommendations are not written for tourists, but for local people and expatriates living in malaria-endemic regions.

C. As a patient, do not hesitate to seek medical advice at any moment! As a doctor, do not hesitate to use reliable, locally available medicines! As a health-minister, recommend these recipes to your country!

D. Please do not reprint this paper without consulting us as we are constantly improving our recommendations according to feedback from out partners.

E. Whenever we speak of "artemisia", we mean leaves made out of original "Artemisia annua anamed" plants, this means with a high medicinal content, that are fresh, or have been properly dried and stored in an air-tight container.

F. For most adults, treatment with artemisia tea alone will be enough. Sometimes, however, additional treatment will be necessary, either in the case of recrudescence, i.e. a repeat attack of malaria within 4 weeks, or if the patient shows no improvement within 24 hours from the time the treatment with artemisia tea commenced. In this latter case, of course, it is always possible that the problem is not malaria.

G. Weighing artemisia tea: Dry artemisia leaves within 3 days at a temperature of up to 45°C, and sieve through a mosquito grid. Weigh this powder on a scale. If you have no scale, one 35mm film container filled with dried artemisia leaves (without pressing) corresponds to 5 grams. If you grind the leaves to a fine powder and you fill the same film container with it, it gives you 10 g of artemisia!
Of course it is better to make your own scales: Hang 2 plastic cups right and left from a piece of wood, as described in our book "Natural Medicine in the Tropics: IV Teachers’ Resource Kit", order number 113. In the left cup, put 5 sheets of ordinary A4 photocopy paper (which weighs 80 g per square meter, i.e. 5g per sheet), in the right cup put fresh artemisia leaves. If the scale is balanced, you have 25 grams of artemisia!

H. Preparation of "anamed artemisia tea": Pour one litre of boiling water over 5 g of dried or 25 g of fresh artemisia leaves, leave to draw for at least 15 minutes and filter. Prepare fresh tea every day – tea must always be used within 24 hours.

I. Sugar in the tea: Normally we are against putting sugar in teas, because it creates dental caries. In the case of malaria, however, the malaria germs destroy the sugar in the blood. Therefore, for children up to the age of one year, you may add sugar to the artemisia tea. For older children, add honey or sugar. But only add the sugar or honey immediately before the tea is drunk, otherwise, during the day, any microbes in the tea may multiply.

J. Honey: Normally we prefer to mix our teas with honey rather than sugar. It is, however, not recommended to give honey to babies in the first 12 months of their life. For children older than one year, it is very good to mix the dried artemisia leaves directly with honey and give it to the patient. However, this preparation needs to be freshly made every day!

K. Preparation of "anamed artemisia sugar": As this medicine will be used for babies, you need to have an extremely clean product.
Wash your hands before harvesting, and take leaves from the upper, cleaner part of the plant. Wash the leaves carefully, and cut and dry them on a clean table. Pound them to a fine powder using only clean instruments. (If available, you may use an electric coffee grinder).
Heat sugar in a saucepan to be sure that all microbes have died and the sugar is quite dry. As soon as the sugar is cold again, mix 10 g of the artemisia powder with 90 g of sugar. If you have no scale, this corresponds to mixing one (1) film container of fine powder of artemisia with three film containers of sugar. One level teaspoon of this preparation weighs 3 g of mixture corresponding to 0.3 g of dried artemisia.
Expiry date: After one year, if kept in an air-tight container.

L. Enema: Supervise the patient to ensure that the enema is not expelled. If it leaves the anus within 30 minutes, give the same amount of enema again.

M. In some countries, chloroquine is no longer used.

Literature

  1. anamed, "Natural Medicine in the Tropics: II Treatments", anamed
  2. WHO/MAL/96.1075 Rev.1 (1997): "Management of Uncomplicated Malaria"
  3. Pussard, Eric et al: "Dose-dependant resorption of Quinine after Intrarectal administration to children with moderate Plasmodium falciparum Malaria", Antimicrobial Agents and Chemotherapy, Nov. 2004, pp. 4422-4426.
  4. Guidelines for the treatment of malaria, second edition, WHO, 2010, http://www.who.int/malaria/publications/atoz/9789241547925/en/index.html