MANAGEMENT OF MALARIA

BY:-K AGASYA RAJ

INVESTIGATION

DIRECTMICROSCOPY

FLOURESCENT STAINING QBC DETECTION OF

ANTIGENSEROLOGICAL

TEST

THICK THINUSED FOR

RAPID STAINING

AND RAPID SCREENIN

GOF SMEARS

TO IDENTIFY MALARIA

L PARASITE

ENZYME IMMUNOASSA

Y TEST

1. ELISA2. RIA3. IIT

4. PCRPARASIT

EIDENTIF

-ICATION

SPECIES

IDENTIFI-

CATIONOptiMAL-

IT

*DIRECT MICROSCOPY IS THE “GOLD STANDARD” IN INVESTIGATION OF MALARIA.

Uncomplicated malaria Regimen(s)Known chloroquine-sensitive strains of P. vivax, P.malariae, P. ovale, P. falciparum

Chloroquine (CQ): 10 mg of base/kg stat followed by 5 mg/kg at 12, 24 and 36 h or by 10 mg/kg at 24 h & 5 mg/kg at 48hORAmodiaquine (10-12 mg of base/kg qd for 3 days

Radical treatment for P. vivax & P. ovale In addition to chloroquine or amodiaquine, primaquine (PQ): 0.25 mg of base/kg once daily with food for 14 days to prevent relapses. In Oceania and South-East Asia: primaquine dose is 0.5 mg/kg body weight.In mild G6PD deficiency, 0.75 mg of base/ kg should be given once weekly for 8 weeks. PQ should not be given in severe G6PD deficiency.

NON Multidrug-resistant (MDR) P. falciparum malaria (Artemisinin combination therapy) ACT-SP: Artesunate (4 mg/kg/day OD for 3 days) plus sulfadoxine (25 mg/kg)/ pyrimethamine (1.25 mg/kg) as a single dose on day 1ORArtesunate (4 mg/kg/day for 3 days) plus amodiaquine(10 mg/kg/day OD for 3 days)

Multidrug-resistant P. falciparum malaria

ACT-AL: Artemether-lumefantrine (1.7/12 mg/kg body weight, respectively, per dose, given twice a day for 3 days with food)ORArtesunate (4 mg/kg/day OD for 3 days) plusMefloquine (25 mg/Kg- either 8.3 mg/kg/ day OD for 3 days or 15 mg/kg on day 2 and then 10 mg/kg on day 3)

TREATMENT OF UNCOMPLICATED MALARIA

Currently, there are four artemisinin compounds that have been recommended by The National Vector Borne Disease Control Program for severe P. falciparum malaria. For treatment initiation, any one of the following four can be used:-1. Artesunate: 2.4 mg/kg i.v. or i.m. given on admission (time=0), then at 12 h and 24 h, then once a day.2. Artemether: 3.2 mg/kg i.m. given on admission then 1.6 mg/kg per day.3. Arteether: 150 mg daily i.m for 3 days in adults only (not recommended for children)4. Quinine: 20 mg quinine salt/kg body weight on admission (IV infusion in 5%-10% Dextrose) followed by maintenance dose of 10 mg/kg 8 hourly; infusion rate not to exceed 5 mg/kg per hour. Loading dose is omitted if the patient has already received quinine.Once the patient can accept, any one of the following three options can be used by the oral route for 7 days:-1. Artemisinin Combination Therapy (ACT) specific (ACT+Lumefantrine) for 3 consecutive days. Primaquin single dose given on day 2. 2. ACT-Sulfadoxine Pyramethamine for 3 consecutive days and Primaquin single dose given on day 2. This regimen is not to be given for treatment of malaria in Northeastern states.3. In those treated with parenteral Quinine, continue with oral Quinine 10mg/Kg every 8 hourly along with either Doxycycline 100 mg daily. Alternatively Clindamycin 10 mg/Kg twice daily can be used in children and pregnant women.

TREATMENT OF SEVERE P. falciparum MALARIA

Chemoprophylaxis of malaria

MALARIA CONTROL

• Indoor residual spraying.• Insecticide treated bed nets.• Electronic mosquito repellants.• Intermittent preventive therapy.

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