A guide for treatment of malaria

A guide for treatment of malaria

Malaria is a difficult disease to control largely due to the highly adaptable nature of the vector and parasites involved. While effective tools have been and will continue to be developed to combat malaria, inevitably, over time the parasites and mosquitoes will evolve means to circumvent those tools if used in isolation or used ineffectively.

Clinical manifestation:

History of travel to endemic area

Fever, chills, rigors, sweat, headache, pallor, jaundice, hepatosplenomegaly.

Diagnostic test:

Stained blood film:

  • Thick blood film: for parasite identification
  • Thin blood film: for species identification

Parasitic index: % of infected RBCs

  • < 1%: mild parasitaemia
  • 1-5%: moderate parasitaemia
  • > 5%: severe parasitaemia

A guide for treatment of malaria

  1. Supportive therapy: for fever, fluid and electrolytes
  2. Specific therapy

Oral therapy: all types of malaria provided that P. Falciparum is susceptible.

– Chloroquine phosphate: 10 mg/kg stat, then 5 mg/kg 6 hours later, then 5 mg/kg/day for 2 consecutive days.

– If no response (no decrease in the parasitaemic index in 24 hours) after consultation of infectious disease department give Fansidar

(Pyrimethamine and sulphadoxine) as single dose. If no response —> Mefloquine hydrochloride as single dose (not in children < 15 kg weight).

Parenteral therapy: For those who have persistent vomiting or who are in coma.

– Quinine dihydrochloride, if not available

– Quinidine gluconate, if not available

– Chloroquine hydrochloride

– Parenteral therapy should be replaced by oral therapy as soon as possible.

Prevention of relapses (plasmodium vivax or p. ovale): —» Primaquine phosphate for 14 days starting in the 3rd day of Chloroquine phosphate.

Chemoprophylaxis:

Starting day: 1 week before traveling to endemic area

End day: 8 weeks after leaving the endemic area

Drugs: Chloroquine is generally preferred: 5 mg/kg/once per week

For Chloroquine resistant area other drugs can be used like: proguanil or fansidar.

The treatment and management recommendations in these guidelines are based on scientific evidence and expert opinion and are frequently updated.


A guide for treatment of malaria

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