Adjuvant treatments and supportive care

In addition to the antimalarial treatment, adjuvant treatments and the improvement of supportive care have the potential to lower the high case fatality rates of severe malaria. Our trials on adjuvant therapies are closely linked to the studies on pathophysiology. We are currently testing the benefit of the anti-helminth drug levamisole as an adjuvant to artesunate for the treatment of severe malaria. Levamisole has shown in the laboratory and in patients with uncomplicated malaria to decrease the ‘stickiness’ of red blood cells harbouring the mature parasites, so that they no longer become stuck in small blood vessels and compromise blood flow in vital organs.   Studies on supportive care include a study on the timing of enteral feeding (through the stomach) in patients with cerebral malaria (early versus late start). Early feeding is beneficial for critically ill patients in well-equipped intensive care units (ICU)  where the patient can be intubated and mechanically ventilated, which protects the airway so that the food doesn’t go the wrong way (into the airways). In hospitals where patients with cerebral malaria are treated intubation is often not possible, so we don’t know if early feeding is good in these patients or if the risk of aspiration of feeds into the lung is too high. Studies on optimizing fluid treatment in severe malaria, using PiCCO monitoring, are currently being performed in Chittagong (Bangladesh) and Rourkela (India).

Improvement of intensive care medicine has a huge potential to improve outcome in critically ill patients including severe malaria. In collaboration with intensivists and IC nurses from The Netherlands and the UK, our unit organizes courses in critical care medicine for local doctors and nurses in developing countries in Asia. We hope that implementation of cost-efficient setting-tailored IC treatments and strategies can measurably improve the performance of IC unit in developing countries in Asia.