In the poorest nations of Africa, malaria remains a killer of epidemic proportions. Young children are often at greatest risk from this disease because their immune systems have not developed sufficient resistance to environmental bacteria and viruses. Public health systems in these resource-deprived nations are often inadequate for preventing or treating malaria on a large scale, as medical technology and techniques are substandard. Children with severe malaria often develop convulsions as their bodies struggle to fight off the infection. Seizures increase the risk of brain injury or other long-term effects, and they can complicate the treatment process. Doctors have fewer options when a child develops seizures, making control of the seizures with an anticonvulsant agent a top priority.
Valium (diazepam) is usually the anticonvulsant medication of choice in the developing regions of Africa. However, this medication has several distinct drawbacks when administered to children. Valium is deposited in fatty tissues fairly easily, meaning the drug stops being effective in a relatively short time. Valium also presents a risk of serious side effects, including fatal respiratory depression. These risks are even more pronounced in children. Economic and political realities have prevented doctors in Africa from exploring safer alternatives until recently.
Studies have shown that Ativan (lorazepam), an anti-anxiety agent like Valium, offers the same benefits for pediatric malarial patients, while presenting far fewer risks. Ativan remains at therapeutic concentrations in the bloodstream for longer periods, reducing the need for continual administration. In addition, there is a smaller risk of dangerous adverse effects with Ativan, as opposed to Valium. A small clinical trial in Kenya demonstrated that one dose of Ativan eliminated seizures in children with malaria in less than 10 minutes, and most children remained convulsion-free for a full 72 hours. Doses were administered both intravenously and intramuscularly, and both methods showed equivalent effectiveness. Three deaths in the trial group were related to the advanced stage of the disease and were not an effect of Ativan. No measurable respiratory or cardiac changes were observed in any of the children.
Controlling seizure is an essential first step in the treatment of childhood malaria, and research has clearly demonstrated both the efficacy and safety of Ativan for pediatric malaria. Unfortunately, Ativan is less readily available in many parts of Africa, forcing doctors to rely on the more dangerous drug Valium. One can only hope that steps will be taken to ensure that more children in need can receive access to Ativan in the treatment of malaria.
- MedlinePlus Drug Information. (n.d.). National Library of Medicine – National Institutes of Health. Lorazepam. Retrieved April 1, 2012, from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682053.html
- Muchohl, S. N., Oblero, K., Newton, C., Ogutu, B. R., Edwards, G., & Kokwaro, G. O. (2007). Pharmacokinetics and clinical efficacy of lorazepam in children with severe malaria and convulsions. British Journal of Clinical Pharmacology, 65(1), 12-21.
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