Malaria - Rx

• Uncomplicated P.Vivax: Chloroquine 3d (10mg/kg 1st day & 2nd day, and 5mg/kg on 3rd day) + Primaquine 15mg (0.25 mg/kg) x 14d (CI- Preg, Infants)
• Uncomplicated P.falcip: ACT (Artemisinin based combinations)
  • artemether + lumefantrine
  • artesunate + amodiaquine
  • artesunate + mefloquine
  • dihydroartemisinin + piperaquine
  • artesunate + sulfadoxine–pyrimethamine (SP).
  eg. Falcigo-SP Kit : Artesunate x 3d, SP on ist day. + Primaquine single dose on day2 (0.75mg/kg) 45mg
• Uncomplicated P.falcip in Preg: Ist Trim: Quinine 10mg/kg tds ie 600mg tds x 7days OR (7-d quinine + Clindamycin)
  2nd Trim: ACT
• Young children and infants: ACT at the same dose in mg/kg
• Uncomplicated Mixed Inf: ACT + Primaquine x 14d.
• Severe Malaria:
  • Artesunate 2.4 mg/kg body weight IV or IM given on admission (time=0h); then at 12 h and 24 h and then O.D. OR
  • Artemether: 3.2 mg/kg body weight IM given on admission and then 1.6 mg/kg body weight per day. OR
  • Arteether (Inj E-Mal) 150mg OD x 3d (not in children) OR
  • Quinine 10mg/kg IV 8 hrly OR 20 mg/kg body weight on admission (IV infusion or divided IM injection) followed by maintenance dose of 10 mg/kg body weight 8 hourly. The infusion rate should not exceed 5 mg salt/kg body weight per hour.
    QUININE: 20mg/kg BW (of dihydrochloride) in 500 ml 5%DNS in 4hrs. 10mg/kg BW in 4hrs (8 hrs after start of starting dose) 8hrly fol. by Tab (10mg/kg) 8hrly - to complete 7days. PEDIATRIC: loading 20mg/kg in 10ml/kg IVF, the 10mg/kg 12hrly.
• Chemoprophylaxis: in high P.falciparum endemic areas only.
  • Short term chemoprophylaxis (upto 6 weeks): Doxycycline: 100 mg once daily for adult and 1.5 mg/kg once daily for children (contraindicated in children below 8 years). The drug should be started 2 days before travel and continued for 4 weeks after leaving the malarious area. Note: It is not recommended for pregnant women and children less than 8 years.
  • Chemoprophylaxis for longer stay (more than 6 weeks): Mefloquine: 250 mg weekly for adults and should be administrated two weeksbefore, during and four weeks after exposure. Note: Mefloquine is contraindicated in individuals with history of convulsions, neuropsychiatric problem and cardiac conditions