Anti malarial treatment

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Anti malarial treatment

  1. 1. Life cycle of malaria parasite & sites of drug action • Radical cure • Causal prophylaxis • Clinical cure • Suppressive prophylaxis Gametocidal
  2. 2. Anti malarial drugs Blood schizontocide Tissue schizontocide  4-Aminiquinolone  Chloroquine ++ 0  Arylamino alcohols  Quinine ++ 0  Mefloquine ++ 0  Antimetabolites  Proguanil + +  Pyrimethamine + 0  Sulfadoxine + 0  Dapsone + 0
  3. 3. Blood schizontocide Tissue schizontocide  Antibiotics  Tetracycline + +  Doxycycline + +  Minocycline + +  8-Aminoquinolone  Primaquine 0 +  Newer drugs  Phenanthrene methanol  Lumefantrine ++ 0  Halofantrine ++ 0  Artimisinin derivatives  Artemether + 0  Artesunate + 0
  4. 4. New guidelines for the treatment of malaria in Sri Lanka Anti Malaria campaign, May 2008 Treatment of microscopically / Rapid Diagnostic Test(RDT) confirmed P.vivax malaria All patients should be given a course of chloroquine base at a dosage of 25mg/Kg over three days. This dose should be divided as follows & given as a single dose per day : 1st day – 10mg/Kg 2nd day – 10mg/Kg 3rd day – 5mg/Kg
  5. 5. All these patients should also be given a course of Primaquine base at a dose of 0.25mg/Kg per day over a period of 14 days (Radical cure) Primaquine is NOT given in pregnant mothers, infants & patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency One tablet of chloroquine contains 150mg of chloroquine base One tablet of primaquine contains 7.5mg
  6. 6. Treatment of microscopically/RDT confirmed uncomplicated P.falciparum malaria All P.falciparum infected patients should be admitted to a medical institution where Artemether-Lumefantrine ( Coartem®) is available The weight appropriated colour of blister packs & dosage (in number of Coartem® tablets) is as follows: 5 - <15kg (yellow) 15 - < 25kg ( blue) 25 - <35kg (orange) > 35kg (green) 0 hours 1 2 3 4 8 hours 1 2 3 4 24 hours 1 2 3 4 36 hours 1 2 3 4 48 hours 1 2 3 4 60 hours 1 2 3 4 Total 6 12 18 24
  7. 7. Chemoprophylaxis for travelers to endemic areas Regimen 1 Mefloquine one 250mg tablet weekly OR Doxycycline one 100mg capsule daily OR Malarone (atovaquone and proguanil)one tablet daily Regimen 2 Chloroquine 300mg weekly ( 2 x 150mg tabs) PLUS Proguanil 200mg daily (2 x 100mg tabs) Regimen 3 Chloroquine 300mg weekly OR Proguanil 200mg daily
  8. 8. Regimen 4 No prophylactic tablets required. But anti mosquito measures should be strictly observed. Avoid mosquito bites by covering up with clothing such as long sleeves & long trousers especially after sunset Using insect repellents on exposed skin When necessary, sleeping under a mosquito net
  9. 9. Drug safety Pregnancy Breast Feeding  Chloroquine ok ok  Paludrine ok ok  Mefloquine ok no  Doxycycline no no  Malarone no no
  10. 10. Individual Anti Malarial drugs Chloroquine Mechanism of action : Chloroquine is concentrated within the infected RBC’s and interferes with degradation of heamoglobin by the parasitic lysosomes resulting in plasmodial membrane damage. It is active against the blood forms & sexual forms Ineffective against many strains of Plasmodium falciparum Safe in pregnancy
  11. 11. Adverse effects  Nausea  Vomiting  Anorexia  Uncontrollable itching  Epigastric pain  Retinal toxicity

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