guidelines for diagnosis and treatment of malaria in india-2009

GUIDELINES FOR DIAGNOSIS AND TREATMENT OF MALARIA IN INDIA

BY:Dr. AYESHA SARWAR.

ACCORDING TO THE REVISED DRUG POLICY, THERE IS NO SCOPE OF PRESUMPTIVE TREATMENT IN MALARIA CONTROL.

THE RECOMMENDED GUIDELINES ARE DISCUSSED UNDER FOLLOWING 2 HEADINGS:

Treatment of uncomplicated malaria.

Treatment of severe malaria.

A] TREATMENT OF

UNCOMPLICATED MALARIA

All fever cases diagnosed as malaria by microscopy or RDT should promptly be given effective treatment.

RECOMMENDED TREATMENT SCHEDULE

1.CHLOROQUINE FOR P.VIVAX & P.FALCIPARUM

AGE in years

DAY 1(10mg/kg)

DAY 2(10mg/kg)

DAY 3(5mg/kg)

<1 ½ ½ 1/4

1-4 1 1 ½

5-8 2 2 1

9-14 3 3 1 ½

15 &above

4 4 2

2.PRIMAQUINE FOR P.VIVAX (DAILY DOSAGE FOR 14DAYS)

AGE(in years)

DAILY DOSAGE in mg base

NO. OF TABLETS(2.5 mg base)

<1 Nil Nil

1-4 2.5 1

5-8 5 2

9-14 10 4

15&above 15 6

3.PRIMAQUINE FOR P.FALCIPARUM (SINGLE DOSE ON FIRST DAY)

AGE in years

DOSAGE(in mg base)

NO. OF TABLETS(7.5mg base)

<1 Nil 0

1-4 7.5 1

5-8 15 2

9-14 30 4

15 &above

45 6

4.ARTEMISININ COMBINATION THERAPY (ACT- ARTESUNATE+SULFADOXINE+PYRIMETHAMINE) FOR P.FALCIPARUM

AGE in years

NO. OF TABLETS ON 1ST DAY

NO. OF TABLETS ON 2ND DAY

NO. OF TABLETS ON 3RD DAY

<1 AS SP

½¼

½Nil

½Nil

1-4 AS SP

11

1Nil

1Nil

5-8 AS SP

21 ½

2Nil

2Nil

9-14 AS SP

32

3nil

3nil

15 &above AS SP

43

4Nil

4nil

AREAS THAT QUALIFY FOR THE ACT:

THEY ARE THE LISTED AREAS WITH HIGH P.falciparum ENDEMICITY IN SEVEN NORTH EASTERN STATES, AP, CHATTISGARH, JHARKHAND, MP & ORISSA.

117 DISTRICTS HAVE BEEN IDENTIFIED FOR THE ACT.

THE INDIVIDUALS WHO QUALIFY FOR THE ACT ARE:

A. THE PATIENTS WITH HISTORY OF TRAVEL TO THE LISTED AREAS

B. WHEN THERE IS NO CLINICAL OR PARASITOLOGICAL RESPONSE TO FULL DOSE OF CHLOROQUINE WITHIN 72hrs OF STARTING THERAPY.

GENERAL RECOMMENDATIONS FOR THE MANAGEMENT OF UNCOMPLICATED MALARIA.

AVOID STARTING TREATMENT ON AN EMPTY STOMACH.

THE FIRST DOSE SHOULD BE GIVEN UNDER OBSERVATION.

DOSE SHOULD BE REPEATED IF VOMITING OCCURS WITHIN 30minutes.

THE PATIENT SHOULD REPORT BACK IF THERE IS NO IMPROVEMENT AFTER 48hrs.

THE PATIENT SHOULD ALSO BE EXAMINED FOR CONCOMITANT INFECTION.

B] TREATMENT OF SEVERE MALARIA.

CLINICAL FEATURES: IMPAIRED CONSIOUSNESS/COMA &

GENERALIZED CONVULSIONS. RENAL FAILURE (serum

creatinine>3mg/dl) JAUNDICE (serum bilirubin>3mg/dl) SEVERE ANEMIA(Hb< 5g/dl) PULMONARY EDEMA/ ACUTE

RESPIRATORY DISTRESS SYNDROME HYPOGLYCEMIA(plasma glucose<40

mg/dl). METABOLIC ACIDOSIS SHOCK(systolic BP<80mmHg) ABNOMAL BLEEDING & DIC HEMOGLOBINURIA HYPERTHERMIA. HYPERPARASITEMIA(<5% parasitized

RBCs)

SPECIFIC ANTIMALARIAL TREATMENT OF SEVERE MALARIA

1] ARTESUNATE:2.4 mg/kg i.v or i.m..given on

admission time, then at 12hrs and 24hrs, then once a day.

(care should be taken to dilute artesunate with 5% sodium bicarbonate provided in the pack)

2] QUININE:20mg/kg i.v on admission followed

by maintainance dose of 10mg/kg 8hrly.

(never give bolus injection of quinine)

3]ARTEMETHER: 3.2mg/kg i.m on admission, then, 1.6mg/kg/day

4]ARTEETHER: 150mgdaily i.m for 3days in adults only.