1. GUIDELINES FOR
DIAGNOSIS AND
TREATMENT OF
MALARIA IN INDIA
BY:
Dr. AYESHA SARWAR.

2. 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.

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

6. RECOMMENDED TREATMENT
SCHEDULE

7. 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
1½
15 &above
4
4
2

8. 2.PRIMAQUINE FOR P.VIVAX (DAILY
DOSAGE FOR 14DAYS)
AGE(in years)
<1
DAILY DOSAGE NO. OF
in mg base
TABLETS
(2.5 mg base)
Nil
Nil
1-4
2.5
1
5-8
5
2
9-14
10
4
15&above
15
6

9. 3.PRIMAQUINE FOR P.FALCIPARUM
(SINGLE DOSE ON FIRST DAY)
AGE in
years
DOSAGE
(in mg
base)
<1
Nil
NO. OF
TABLETS
(7.5mg
base)
0
1-4
7.5
1
5-8
15
2
9-14
30
4
15 &above 45
6

10. THERAPY (ACTARTESUNATE+SULFADOXINE+PYRIMETHAMINE
) FOR P.FALCIPARUM
AGE in
years
<1
AS
NO. OF
NO. OF
TABLETS
TABLETS
ON 1ST DAY ON 2ND
DAY
½
½
¼
Nil
NO. OF
TABLETS
ON 3RD
DAY
½
Nil
SP
1-4
AS
1
1
1
Nil
1
Nil
SP
5-8
2
2
2

11. AREAS THAT QUALIFY FOR THE
ACT:
 THEY
ARE THE LISTED AREAS WITH
HIGH P.falciparum ENDEMICITY IN
SEVEN NORTH EASTERN
STATES, AP, CHATTISGARH, JHARKHAN
D, 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

12. 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

13. B] TREATMENT OF
SEVERE MALARIA.

14. 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.


15. 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)