Treatment of malaria

1. Himal Pandey
MBBS 2014Aug.

2.  Complete cure
 Prevention of progression of uncomplicated malaria to
severe disease
 Prevention of death
 Interruption of transmission
 Prevention of drug resistant malaria

3. Classification of Malaria treatment
1. Treatment of uncomplicated malaria
2. Treatment failure and drug resistance
3. Treatment of severe malaria
4. Chemoprophylaxis

4. Biguanides
◦ Proguanil,
Chlorproguanil
Diaminopyrimidines
◦ Pyrimethamine
Sulfonamides
◦ Sulfadoxine, dapsone
Tetracyclines:
◦ tetracycline, doxycycline
Naphthoquinone:
◦ Atovaquone
Sesquiterpene lactones:
◦ Artesunate, artemether,
arteether
4-aminoquinolines:
Chloroquine,
Hydroxychloroquine,
Amodiaquine,
Pyronaridine
8-aminoquinolines:
Primaquine,
Tafenoquine, Bulaquine
Cinchona alkaloids:
Quinine, Quinidine
Quinoline methanol:
Mefloquine

5. Suspected case
Diagnosis:RDT/Microscopy
Positive Negative
Falciparum High
suspicion--
Signs and
symptoms of
Malaria +ve
Uncomplicated
Severe
malaria
Severe
malaria
Non-
falciparum
Look for
other
causes
Low
suspicion
Anti malarial
treatment
along with
further
investigation
Uncompli
cated
Note:Mixed infections Should be
treated as Falciparum Malaria

6. A case of uncomplicated malaria usually presents with
-Fever,
-Rigors,
-Headache,
-Bodyache,
-Fatigue,
-Anorexia and nausea.

7. 1. Chloroquine: 25 mg/kg body weight divided over
three days i.e.
– 10 mg/kg on day 1,
– 10 mg/kg on day 2 and
– 5 mg/kg on day 3.
2. Primaquine: 0.25 mg/kg body weight daily for 14 days.
• Primaquine is contraindicated in infants, pregnant
women and individuals with G6PD deficiency

8. 1. Artemisinin based Combination Therapy (ACT-SP)
Artesunate ----4 mg/kg daily for 3 days +
Sulfadoxine ----25 mg/kg body weight and
Pyrimethamine --1.25 mg/kg body weight) on first
day
2. Primaquine: 0.75 mg/kg body weight on day 2
Note: ACT-AL --Co-formulated tablet of artemether (
20 mg) + lumefantrine (120 mg) for 3 days Can be
given in place of ACT-SP

10.  If vomiting occurs within 30 minutes of intake – Dose
should be repeated
 Other considerations
 Avoid drug in empty stomach
 Patient should report back if there is no improvement
after 48 hrs or the situation worsens.

11. 1. Cure
2. Early treatment failure
3. Late clinical failure
4. Late parasitological failure
T/t-
Alternative ACT or Quinine with Doxycycline
Note: Doxycycline C/I in pregnancy, lactation and children <8yr

13.  Impaired consciousness
 Convulsions
 Renal Failure
 Jaundice
 Severe anemia
 Respiratory Distress
 Hypolgycemia, Metabolic acidosis
 Shock
 Bleeding
 Haemoglobinuria

15.  Short term chemoprophylaxis (up to 6 weeks)
◦ Doxycycline : 100 mg once daily
◦ 1 days before travel and continued for 4 weeks
after leaving the malarious area
 Chemoprophylaxis for longer stay (> 6
weeks)
◦ Cloroquine 300 mg weekly
◦ Mefloqiune: 250 mg weekly for adults