Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Giving paracetamol (acetaminophen) to patients ill with severe malaria made them less likely to develop potentially fatal kidney failure. Each year severe malaria causes close to half a million deaths globally. Acute kidney injury occurs in 40% of adults and at least 10% of children with severe malaria, killing an estimated 40% of these adults and 12-24% of the children. The study reported for the first time that giving regular doses of paracetamol protects the kidney in adult patients with severe falciparum malaria.

Health care workers managing a patient © Photo by Alexander Kumar © MORU 2018

10 April 2018 (Bangkok) – Giving paracetamol (acetaminophen) to patients ill with severe malaria made them less likely to develop potentially fatal kidney failure, say researchers in a recent study in Clinical Infectious Diseases.

The study reported for the first time that giving regular doses of paracetamol protects the kidney in adult patients with severe falciparum malaria. Each year severe malaria causes close to half a million deaths globally. Acute kidney injury (AKI) complicating severe malaria is an important cause for death.  AKI occurs in 40 % of adults and at least 10 % of children with severe malaria, killing an estimated 40 % of these adults and 12-24 % of the children.

“This is an important finding, because acute kidney injury is a very common, often fatal complication in adult patients with severe malaria,” said Oxford Prof Arjen Dondorp, Head of Malaria Research at the Mahidol-Oxford Tropical Medicine Research Unit (MORU) in Bangkok. “Surprisingly simple and cheap paracetamol can protect the kidney in severe malaria and thus has the potential to reduce deaths from malaria.”

Noting that the numbers in African children with severe malaria and AKI may be underestimated because renal function was not systematically checked and cut-off values not well defined, Prof Dondorp said, “This finding now needs to be tested in African children with severe malaria.”

Funded by Wellcome and conducted by a MORU team with Bangladeshi collaborators at study sites in Chittagong and Ramu, Bangladesh, the study was led by Dr Katherine Plewes, a Vancouver, Canada-based MORU researcher.

An extensive series of earlier studies had linked the level of intravascular rupture of red blood cells (haemolysis) with oxidative stress markers (the haemoglobin released by the red blood cells is very oxidative) and kidney damage.

Dr Plewes had shown in an earlier paper that the frequent, often fatal complication of kidney failure was closely linked to the level of haemolysis. After another study in rats showed that paracetamol reduced the oxidative properties of haem, and protected the rat kidney, Dr Plewes and her team set up a clinical trial to test paracetamol as an inexpensive, safe intervention in patients with severe malaria.  

Remarkably, this study showed that patients – especially those with a high level of haemolysis – who were given paracetamol developed less kidney failure than patients who weren’t given paracetamol.

“Paracetamol is potentially the first beneficial adjuvant therapy to be discovered for severe malaria,” said Dr Plewes. “We are now testing paracetamol in P. knowlesi malaria, a monkey malaria that easily skips species to humans and often causes renal failure, to confirm our study findings.”

Reference

Acetaminophen as a Renoprotective Adjunctive Treatment in Patients with Severe and Moderately Severe Falciparum Malaria: A Randomized, Controlled, Open-Label Trial.Plewes K, Kingston HWF, Ghose A, Wattanakul T, Hassan MMU, Haider MS, Dutta PK, Islam MA, Alam S, Jahangir SM, Zahed ASM, Sattar MA, Chowdhury MAH, Herdman MT, Leopold SJ, Ishioka H, Piera KA, Charunwatthana P, Silamut K, Yeo TW, Lee SJ, Mukaka M, Maude RJ, Turner GDH, Faiz MA, Tarning J, Oates JA, Anstey NM, White NJ, Day NPJ, Hossain MA, Roberts LJ 2nd, Dondorp AM. Clin Infect Dis. 2018 Mar 12. doi: 10.1093/cid/ciy213. [Epub ahead of print]

Similar stories

Incomplete reporting of COVID-19 disease severity criteria compromises meta-analysis

Patients affected by COVID-19 should be treated according to the severity of their disease. However, not all key national or international organisations define severity in the same way. This imprecision in severity assessment compromises the validity of some therapeutic recommendations. Using individual patient data would better guide and improve therapeutic recommendations for COVID-19.

Field evaluation of EasyScan GO: a digital malaria microscopy device

Microscopic examination of Giemsa-stained blood films is key to quantifying and detecting malaria parasites but there can be difficulties in ensuring both a high-quality manual reading and inter-reader reliability. The EasyScan GO was developed as a potential solution to this, a microscopy device using machine-learning-based image analysis for automated parasite detection and quantification.

Congratulations Professor Sir David Warrell, appointed Knight Commander of the Order of St Michael and St George

David Warrell, our founding director, has been appointed by the Queen ‘Knight Commander of the Order of St Michael and St George for services to global Health Research and Clinical Practice’. Please join us in congratulating Sir David on receiving this richly deserved high honour!

Patient recruitment on track in Oxford-led DeTACT trial of safe, effective drug combinations to prevent the spread of artemisinin and multi-drug resistant malaria in Africa

Today is World Malaria Day. The global fight against malaria is at a critical point. No new antimalarial drugs are expected in the near future, and if multi-drug resistant falciparum malaria becomes established in East Africa and spreads to other parts of Africa, millions will be at risk of drug-resistant malaria infection and death. The development of triple artemisinin-based combination therapies aims to prevent or delay the emergence of artemisinin and multi-drug resistant malaria in Africa.

TACT-CV study shows artemether–lumefantrine plus amodiaquine an effective treatment for multidrug-resistant malaria in GMS

A triple artemisinin-based combination therapy (TACT) of artemether-lumefantrine plus amodiaquine (AL+AQ) for uncomplicated falciparum malaria in areas with a high prevalence of artemisinin resistance is a well-tolerated, effective treatment for multidrug-resistant parasites, say a team of MORU-led researchers.

Largest-ever IPD meta-analysis of malaria patients to inform haemoglobin changes

A new malaria study using a very large analysis of pooled individual patient data (IPD) from more than 70,000 patients of all ages, has been published in BMC Medicine by the WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group