If a patient develops malaria despite adhering to prophylaxis, immediate clinical assessment and treatment with a full therapeutic antimalarial regimen appropriate for the species and resistance pattern is essential, as prophylaxis failure may indicate drug resistance or inadequate drug levels NICE NG63.
Confirm adherence and review the prophylactic regimen to ensure correct dosing and timing, as well as consider potential drug interactions or malabsorption that could reduce prophylactic efficacy NICE NG63.
Switch to a different class of antimalarial treatment for the acute infection, avoiding the prophylactic agent used, to overcome possible resistance Crider et al. 2022.
Monitor the patient closely for complications and treatment response, as breakthrough malaria can sometimes present more severely despite prophylaxis NICE NG63.
Additionally, consider nutritional and folate status since folic acid supplementation may influence susceptibility and severity in patients taking antifolate antimalarials, which could impact treatment choices Crider et al. 2022.
Finally, report the case to public health authorities to contribute to surveillance of prophylaxis failures and resistance patterns NICE NG63.
Key References
- NG63 - Antimicrobial stewardship: changing risk-related behaviours in the general population
- CG76 - Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence
- NG33 - Tuberculosis
- (Crider et al., 2022): Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas.