India is an endemic area for malaria and we have two species of Malarial parasite seen commonly – the ubiquitous pl. Vivax, and the recently increased pl. Falciparum. Pl. Ovale is less common and its treatment is similar to Pl. Vivax
Vivax Malaria: Pl. Vivax is benign, and only causes fever with chills. It responds quickly chloroquin. There is "No" chloroquin resistance, but it has a hepatic dormant stage, which is not affected by chloroquin. So after a few days it recurs. Hence, for complete cure, tissue schizonticide i.e. Primaquin should be given.
Treatment: Tab. RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16695'>RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16694'>RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16695'>RESOCHIN 300mg x 4 stat (after food) then 2 tabs after 6 hrs Then 2 tabs daily x 2 days (chloroquin = 7F-l) [To be given with antacids (1A) and anti-emetics (Siquil or Perinorm = 1D)] Tab. Primaquine&actContent=MALARIA&redTo=disease&drg_tid=45884'>Primaquine 7.5mg 1bd x 14 days (7F-3)
If oral treatment is not tolerated, 1. Inj. RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16695'>RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16694'>RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16695'>RESOCHIN 5l IM x 6 hrly x 7 doses. (Total dose of 25mg/kg)
In sever cases, Inj. RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16695'>RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16694'>RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16695'>RESOCHIN 15ml n N saline x so I.V. over 89 hrs, then 20ml RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16695'>RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16694'>RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16695'>RESOCHIN slow I.V. over next 24 hrs
Falciparum Malaria: This is a dangerous form of malaria affecting different organs, mainly the brain, causing cerebral Malaria which can be fatal.
The second problem, which is of recent origin, is of chloroquin Resistance – necessitating the use of other drugs.
Standard Treatment – Tab. RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16695'>RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16694'>RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16695'>RESOCHIN 300mg 4 stat (after food & antacids) Then 2 tabs after 6 hrs. Then 2 tabs daily x 2 days (Chloroquin = &f-1)
Tab. Amlar x tabs stat – single dose. (Sulphadoxime + Pyrimethamine = 7F-6)
If chloroquin Resistant Falciparum Malaria Tab. Amlar 3 tabs stat-single dose (7F-6) Cap. Doxy- 1 100mg 2 times/day x 7 days (Doxycyclin = 7A-4D) Tab. Quinarsol 300mg x tabs x 3 times/day x 7days (quinine = 7F-4) OR Tab. MQF 250 mg x tabs stat x after food, with 2 glasses of water, then 2 tabs after 6 hrs. (Mefloquin =7F-5) OR Tab. Arnate 50mg 2 tabs sat, then 1 bd x 4 days (Artesunate =7F-9)
OR Inj. PALUTHER 80mg IM x 12 hrly x 3 days (Artesuante = 7F-10)
In Severe Case or Cerebral Malaria Inj. QUININGA 300mg/ml x 4 ml in 55 dextrose drip x slow I.V. over 4 hrs x hrly (7F-4) Inj. FALCIGO (60mg vial) x www vials IM OR I.V. stat Then 60mg IM/I.V. daily x 4 days (7f-9) OR Inj. PALUTHER 80mg IM 12 hrly x 3 days (7f-10)
Prophylaxis for Travelers to Endemic Area:
A) For all types of malaria: - Tab. RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16695'>RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16694'>RESOCHIN&actContent=MALARIA&redTo=disease&drg_tid=16695'>RESOCHIN 300mg once every wk, continued for 8 wks. After leaving the endemic area. (7F-1) T. Primaquin 7.5mg bd x 14 days in last 2 wks of chloroquin prophylaxis
B) For Falciparum Malaria: Tab. Laveran 100mg 1 Tab. Daily (Proguanil = 7F-7) From 1 wk before travel, to 4 wks after leaving the endemic area. OR Tab. Mefloquin 250mg x 1 Tab. Every wk (7F-5) X from 1 week prior, to 2 wks after. If stay is prolonged, after 1 month give ½ Tab. Every week.
