Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. 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.

MORU's Dr Katherine Plewes and Dr Stije Leopold examine a malaria patient in Chittagong, Bangladesh (Nov 2017) © 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

Pint of Science Thailand is back

MORU Bangkok Public Engagement

Live and on-line from Bangkok! Be ready for Thursday 13th May, when Pint of Science Thailand will stream live from Bangkok. Join us via Facebook, YouTube or right here from the Pint of Science Thailand website as we journey from bacterial infections to viruses, discover how clinical trials work, and how scientific development is seen in the eyes of the law!

Innovative strategies for engaging communities with malaria research

MORU Bangkok Public Engagement

For World Malaria Day 2021, F1000 Research Blog spoke to Professor Phaik Yeong Cheah about her research focussed on drama and arts-based community engagement for malaria research, published with Wellcome Open Research.

New project’s child-appropriate primaquine doses could have significant impact on global burden of malaria

MORU Bangkok

On Sunday 25 April, World Malaria Day, the Developing Paediatric Primaquine (DPP) project will launch its website. DPP will produce children-appropriate primaquine doses that could both cut malaria deaths in vulnerable African children by blocking transmission of P. falciparum malaria and reduce P. vivax malaria more widely.

Researchers call for access to Ivermectin for young children

MORU Bangkok Publication Research

Millions of children weighing less than 15kg are currently denied access to Ivermectin treatment due to insufficient safety data being available to support a change to the current label indication. The WorldWide Antimalarial Resistance Network’s new meta-analysis provides evidence that supports removing this barrier and improving treatment equity.

New report highlights growing concern of vaccine falsification

MORU Bangkok

The Medicine Quality Research Group has published a new Medical Product Quality Report focussing on increasing issues around substandard and falsified (SF) COVID-19 vaccines. With the implementation of the key innovations of COVID-19 vaccines, there have been growing numbers of reports of SF vaccines in the public domain. Given the vital role they will play in ending the pandemic and protecting the global population but severe issues with equitable access, SF vaccines are highly likely to be a growing problem.

Evidence supports WHO recommendation for primaquine combined with ACTs to block Plasmodium falciparum transmission

MORU Bangkok Publication Research

Evidence from a new study, initiated by the Primaquine Roll Out Group and conducted at WWARN, supports the World Health Organization (WHO) recommendation for use of 0.25mg/kg dose of primaquine (PQ) combined with artemisinin-based combination therapies (ACT) to block Plasmodium falciparum transmission.