6 Treatmentmalaria Final

Control of malaria

MANAGEMENT OF MALARIA CASES:

• FIRST PRIORITY -CLINICAL MANAGEMENT FOR MORBIDITY, MORTALITY REDUCTION

ROLE OF PHCs:

HEALTH GUIDES,MULTI PURPOSE WORKERS TRAINED TO DETECT CASES

DRUG DISTRIBUTION CENTRES,FEVER TREATMENT DEPOTS

TREATMENT OF MALARIA

MANAGEMENT:MANAGEMENT:

LARGE HOSPITAL:LARGE HOSPITAL:

ideally should have the following facilities:

Round-the-clock coverage by qualified doctors and nurses

Facilities for intravenous infusion and central venous monitoring

Microscopy and rapid diagnostic test

Routine blood, urine,stool, biochemical tests

Blood transfusion

Oxygen therapy and ventilatory support

Facilities for doing a lumbar puncture

Facilities for specialized biochemical, radiological,microbiological tests

Facilities for intensive care management of critically illpatients

Facility for peritoneal/haemodialysis

SMALL HOSPITALS:SMALL HOSPITALS:Small hospitals/health facilities

are likely to have fewer than 50 beds.

Laboratory facilities are minimalOxygen is generally not availableblood transfusion facility may not

be available.Referral of patients with severe

malaria is advised.

BEFORE REFERAL:BEFORE REFERAL:PRE-REFERAL TREATMENTPREPARE REFERAL CARDADVICE TO ATTENDANTWHEN TRANSFERING:1.MAINTAIN A,B,C2.INSERT URINARY CATHETER IF

NEEDED3.START ANTI-MALARIAL THERAPY

REFERAL NOT POSSIBLE:REFERAL NOT POSSIBLE:FIRST AIDI.V FLUIDSSPECIFIC ANTI-MALARIAL

TREATMENTSUPPORTIVE MANAGEMENT

DISEASE CONTROL DISEASE CONTROL STRATEGIESSTRATEGIESCASE DETECTIONTREATMENTMASS DRUG ADMINISTRATION

CHEMOPROPHYLAXIS

CASE DETECTION:CASE DETECTION: ADULTS: NATIONAL DRUG POLICY ON MALARIA,2008

ALL FEVER CASES INVESTIGATED FOR MALARIA USING MICROSCOPY & RAPID DIAGNOSTIC USING MICROSCOPY & RAPID DIAGNOSTIC

KIT.KIT. FIRST LINE:CHLOROQUINE RESISTANT:ACT

(ARTESUNATE+SULPHADOXINE+PYRIMETHAMINE)

CHILDREN: CLASSIFY BASED ON

SIGNS&SYMPTOMS ,RISK CATEGORY OF THE AREA…..

ADULTS:ADULTS:CLINICAL MALARIA: IF RAPID DIAGNOSTIC KIT USED

FOR P.FALCIPARUM ONLY,NEGATIVE CASES SHOWING SIGNS AND SYMPTOMS OF MALARIA WITHOUT ANY OBVIOUS CAUSE-CLINICAL MALARIA

DIAGNOSIS WITH MICROSCOPY,RDK NOT POSSIBLE,CASE WITH SIGNS & SYMPTOMS OF MALARIA – CLINICAL MALARIA

CHILDREN:CHILDREN:VERY SEVERE FEBRILE VERY SEVERE FEBRILE DISEASE:DISEASE: FEVER + ANY GENERAL DANGER

SIGNS OR STIFF NECK -CLASSIFY AS VERY SEVERE

FEBRILE DISEASE -URGENT REFERAL + PRE

REFERAL TREATMENT WITH ANTIBIOTICS

NOTE: IN AREAS WHERE P.FALCIPARUM PRESENT- PRE REFERAL DOSE OF I.M. QUININE GIVEN

HIGH RISK AREA:HIGH RISK AREA: FEVER + NO GENERAL DANGER

SIGNS OR STIFF NECK-MALARIA TREATMENT JUSTIFICATION: HIGH RATE OF MALARIA

RISK IN AREA POSSIBILITY OF ANOTHER

ILLNESS CAUSING MALARIA TO PROGRESS

LOW MALARIA RISK AREA:LOW MALARIA RISK AREA:

FEVER + NO GENERAL DANGER SIGNS + NO MEASLES +NO OTHER CAUSE OF FEVER - MALARIA

RUNNY NOSE PRESENT OR MEASLES

PRESENT - FEVER MALARIA UNLIKELY

TREATMENT:TREATMENT:NATIONAL

MALARIA CONTROL PROGRAMME(1953-58)

-ANTI MALARIALS HAD LITTLE ROLE

NATIONAL MALARIA ERADICATING PROGRAMME(1958-TILL DATE)

-THEY HAVE AN IMMENSE ROLE

UNCOMPLICATED MALARIA-UNCOMPLICATED MALARIA-CHLOROQUINE:CHLOROQUINE:ALL SUSPECTED,CLINICAL MALARIA CASES:

PRIMAQUINE:PRIMAQUINE:

CHLOROQUINE:CHLOROQUINE:AGE(YRS) DAY 1 DAY 2 DAY 3

<1 ½ ½ ¼

1-4 1 1 ½

5-8 2 2 1

9-14 3 3 1 ½

>15 4 4 2

EACH TAB CONTAINS 150MG(BASE)

PRIMAQUINE-PRIMAQUINE-P.FALCIPARUMP.FALCIPARUMAGE(YRS) MG BASE NO OF TABLETS

<1 - -

1-4 7.5 1

5-8 15 2

9-14 30 4

>15 45 6

GIVEN AS SINGLE DOSE ON DAY ONE

PRIMAQUINE-PRIMAQUINE-P.VIVAXP.VIVAXAGE(YRS) MG BASE NO OF TABLETS

<1 - -

1-4 2-5 1

5-8 5 2

9-14 10 4

>15 15 6

GIVEN FOR 14 DAYS

ACT:ARTESUNATE+ ACT:ARTESUNATE+ SUFADOXINE/PYRIMETHAMINSUFADOXINE/PYRIMETHAMINEEAGE(YRS) DAY 1 DAY 2 DAY 3

<1 ½+ ¼ ½ +- ½ +-

1-4 1 + 1 1+- 1+-

5-8 2+1 ½ 2+- 2+-

9-14 3+2 3+- 3+-

>15 4+3 4+- 4+-

EACH TAB OF:ARTESUNATE CONTAINS 50MG ARTESUNATES/P CONTAINS 500MG SULFADOXINE+ 25MG PYRIMETHAMINENOT RECOMMENDED IN PREGNANCYOTHER COMBINATIONS:ATRESUNATE+MEFLOQUINE ARTEMETHER+LUMEFANTRINE

NO RDK,MICROSCOPY AVAILABLE: NO RDK,MICROSCOPY AVAILABLE: LOW RISK AREALOW RISK AREA

NO RDK,MICROSCOPY NO RDK,MICROSCOPY AVAILABLE:HIGH RISK AREA:AVAILABLE:HIGH RISK AREA:

SEVERE COMPLICATED SEVERE COMPLICATED CASES:CASES: I.V.QUININE – 10MG/KG B.WT IN 5%

DEXTROSE SALINE OVER 4 HOURS, 8 HOURLY SWITCH TO ORAL DOSE AS SOON AS

POSSIBLE TOTAL DURATION OF TREATMENT = 7 DAYS INJ.ARTESUNATE CAN BE USED IN

ADULTS,NON PREGNANT WOMEN ARTESUNATE 2.4 MG/KG B.WT I.M/I.V

FOLLOWED BY 1.2MG/KG B.WT AFTER 12HRS THEN,1.2MG/KG B.WT AFTER 4 HOURS

NOTE:NOTE:SULFADOXINE/PYRIMETHAMINE

NOT USEFUL IN VIVAX MALARIAPRIMAQUINE CONTRA INDICATED IN

PREGNANT WOMEN,INFANTS,G-6-P-D DEFICIENCY

ACT NOT USEFUL IN VIVAX MALARIA.

ACT SHOULD BE GIVEN ONLY TO CONFIRMED P.FALCIPARUM MALARIA CASES.

TOXIC HAZARDS OF TOXIC HAZARDS OF DRUGS:DRUGS:CHLOROQUINE: NAUSEA,VOMITTING,HEADACHE,BLURRING

VISION,RETINAL DAMAGE(LONG TERM USE)PRIMAQUINE: GI EFFECTS,CNS,HEMOLYSIS(CVS) IN G-6-

PD DEFICIENT PEOPLE-stop primaquine immediately if he develops

symptoms like darkcoloured urine, yellow conjunctiva, bluish

discolouration of lips,abdominal pain, nausea, vomiting etc. and

should report to thedoctor immediately

DISEASE CONTROL DISEASE CONTROL STRATEGIESSTRATEGIESCASE DETECTIONTREATMENTMASS DRUG ADMINISTRATION

CHEMOPROPHYLAXIS

MASS DRUG MASS DRUG ADMINISTRATIONADMINISTRATION WHO REVISED STRATEGY: IT IS RECOMMENDED IN HIGHLY ENDEMIC

AREAS FOR CURBING TRANSMISSION+EXTENSIVE ANTIMOSQUITO MEASURES

MASS DRUG ADMINISTRATION IN CHILDREN <5YRS NOT RECOMMENDED :

1. MAY INTEFERE WITH DEVELOPMENT OF PROTECTIVE IMMUNITY

2.ACCLERATE DRUG RESISTANCE3.SCARCE RESOURSES MAY BE BETTER

USED FOR TREATMENT4.RISK OF RETINOPATHY

CHEMOPROPHYLAXISCHEMOPROPHYLAXIS RECOMMENDED FOR 1.TRAVELLERS FROM NON ENDEMIC

AREAS2.SHORT TERM FOR SOLDIERS,POLICE

FORCE,LABOUR FORCES DURING WORK IN ENDEMIC AREAS

3.PREGNANT WOMEN IN AREAS OF HIGH TRANSMISSION(BUT PROMPT TREATMENT OF CLINICAL EPISODES RECOMMENDED)

COMPLEMENT WITH PERSONAL PROTECTION

SHOULD BEGIN 1 WEEK BEFORE ARRIVAL IN MALARIOUS AREA,CONTINUED 4 WEEKS AFTER LEAVING THE AREA.

SIDE EFECTS OF CHLOROQUINE WITH LONG USE-

1.300MG WEEKLY FOR 5 YRS SCREEN TWICE YRLY FOR RETINAL CHANGES

2.100MG DAILY DOSE – START SCREENING AFTER 3 YRS

CHEMOPROPHYLAXIS:CHEMOPROPHYLAXIS:DRUG THERAPEUTIC

DOSEPROPHYLAXIS

CHLOROQUINE 100/150 MG BASE 300MG

PROGUANIL 100 MG 200MG 2 TAB OD

MEFLOQUINE 250 MG 250MG 1/WEEK(SAME ADY EACH WEEK

DOXYCYCLINE 100 MG 100MG 1 CAP OD