MALARIA

Anopheles culicifacies

MALARIA PARACYTES
PLASMODIUM VIVAX
PLASMODIUM FALCIPARUM
PLASMODIUM MALARIAE
PLASMODIUM OVALAE

Treatment
Radical Cure ( Tissue schizonticidal )
Primaquine
Prevent Transmission ( Primaquine )
Chemoprophylaxis ( Chloroquine,
Doxycycline)
Blood Schizonticidals Chlorquine
(Acute attacks)

Chloroquine
Schizonticidal drug against
erythrocytic forms
P.Falciparum resistence to CQ
SAFE in PREGNANCY

CQ contd:--

Mode of action
Accumulate in parasitized rbc
Forms complexes with plasmodial
DNA

CQ contd:--

Preparations & administration

Oral-CQ sulphate 200mg (CQ
base 150mg)
Syrup-CQ sulphate 68mg/5ml(CQ
base 50mg/5ml)
Injections-CQ sulphate
54.5mg/ml(CQ base 40mg/ml)
im,iv, sc

Primaquine PQ
Is a hypnozidal drug (radical
cure)
&
a gametocidal drug (prevent
transmission)

Primaquine
C/I
Pregnancy
Children < 1yr
G6PD deficiency

PQ contd--

Side-effects
GIT disturbances
Methhaemoglobinaemia
Heamolytic anaemia in G6PD
deficiency (important to obtain H/O and family
history. Advice patients about recognizing the symptoms)

Quinine

Quinine contd--

Side-effects
Bitter taste
GIT disturbances
Hypersensitivity reactions
Hypotension, cardiac arrythmias

Blood disorders thrombocytopenia,

black water fever (acute haemolytic
anaemia with Pf infection)

Quinine side-effects
contd--

Stimulate insulin secretionHypoglycemia (especially after

parentral therapy)
Cinchonism nausea, dizziness,
tinnitus, head ache, hot & flushed
skin, blurring of vision (plasma
concentration>30-60mol/l

Artemisnin combination therapy

(ACT)

Coartem
Artemether
+
Lumefantrine
A tablet contains 20mg Artemether
& 120 mg Lumefantrine

ACT contd--

Advantages of Coartem rapid clinical improvement

rapid clearance of parasitemia
no documented parasitic resistance
Low relapse rate
reduce gametocyte carriage rate rapidly
generally well tolerated
fixed dose combination, improves
compliance
Prescribed according to the weight

Treatment regimes
Monoinfection with P vivax)
day 1
600mg CQ sulphate (4tabs) as a single
dose
day 2
600mg CQ sulphate(4tabs) as a single
dose
day 3
300mg CQ sulphate (2tabs) as a single
dose

Treatment of severe & complicated Pf

infection contd--

Quinine dihydrochloride 10mg/kg

in 5% dextrose over 4-6 hrs
repeated 8hrly until the patient is able to take orally

full course of Coarterm)

single dose of PQ

Treatment of severe &

complicated Pf & Pv mixed
infection
Parenteral quinine hydrochloride 10mg/kg
in 5% dextrose
8hrly until the patient is able to take orally
full course of Coartem
PQ should be given for 14 days

Uncomplicated falciparum malaria

in pregnancy
1st trimester
Quinine sulphate -10mg/kgbody wt
8hrly for 7days
2nd & 3rd trimester
Coartem
PQ contraindicated in pregnancy
PQ given 6 weeks after delivery

Severe complicated P falciparum

infection in pregnancy
1st trimester
Parenteral quinine
followed by oral quinine for 7days
2nd & 3rd trimester
Parenteral quinine.

After clinical improvement

weight appropriate coartem
PQ given 6 weeks after delivery

Chemoprophylaxis
Only suppress clinical illness
Who needs chemoprophylaxis?
Pregnant mothers in endemic areas
Foreign travelers coming from nonmalarial areas
Non-immune local residents traveling
to endemic areas on temporary basis
Refugees deployed in endemic areas

Cerebral malaria
Specific treatment
Quinine dihydrchloride 20mg /Kg
in N saline iv infusion over 4hrs (loading
dose)

12hrs after the start of the dose

Quinine 10mg /kg infusion over 4hrs
(maintenance dose )

Cerebral malaria contd-Maintenance dose should be repeated 8hrly until patient can
swallow,

oral quinine 10mg/kg 8hrly 7days

If parentral therapy has to be
continued for more than 48hrs
reduce the maintenance dose by
1/3rd-1/2 8hrly
Loading dose should not be used if
patient has received quinine within
the preceding12 hrs

Cerebral malaria
Quinine dihydrchloride 20mg /Kg in
N saline iv infusion over 4hrs (loading
dose)
12hrs after the start of the dose
Quinine 10mg /kg infusion over 4hrs ,
8hrly(maintenance dose )

Cerebral malaria contd--

then oral quinine 10mg/kg 8hrly

7days

Cerebral malaria contd--

Complications
Hyperpyrexia, coma & convulsions
Dehydration
Hypoglycemia
Acute pulmonary oedema
Acute renal failure
Severe anaemia
bleeding