Malaria by affan ali(036)

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Malaria A Case Study & Standard Treatment

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Malaria by affan ali(036)

  1. 1. Affan Ali Roll No. 36 CASE STUDY
  2. 2. Demographics Name: Muhammad Ali  Age: 21 Years  Gender: Male  Marital Status: Un Married  Ward: Medicine  Hospital: Dow University Hospital 
  3. 3. History No Disease History  Not on Medication 
  4. 4. Present Complains Morning & Midnight High Grade Fever for 5days  Chills for 5days  Vomiting for 1 day  Epigastric Pain  Sweating  Weakness 
  5. 5. Laboratory Findings Haemoglobin • 11.3g/dl RBCs • 3.7 x108/µl MCV • 93 fl MCH • 31 pg MCHC • 33% PCV • 34%
  6. 6. Laboratory Findings Total Leukocytes • 3.1 x103/µl Neutrophils • 29% Eosinophils • 1% Basophils • 0% Monocytes • 11% Lymphocytes • 59% Platelets • 95 x103/µl
  7. 7. Laboratory Findings Sodium • 140 mEq/l Potassium • 3.4 mEq/l Chloride • 105 mEq/l Bicarbonate • 29 mEq/l Urea • 42.4mg/dl Sr. Creatinine • 0.9 mg/dl
  8. 8. Laboratory Findings Dengue IgG P. Falciparum P. Mix Typhi Dot Negative Negative Positive Negative
  9. 9. Diagnosis
  10. 10. PRESCRIPTION
  11. 11. Ceftriaxone
  12. 12. Artemether/ Lumefantrine
  13. 13. Omeprazole
  14. 14. Metoclopramide
  15. 15. Acetaminophen
  16. 16. Vitamin B Complex
  17. 17. Others Dextrose Saline @ 100cc/hour  Normal Saline @ 100 cc/hour 
  18. 18. JUSTIFICATIONS
  19. 19. Ceftriaxone Prescribed for Prophylaxis of Hospital Acquired Infections  Dose is Accurate (1- 4gm daily A/C severity)  Frequency is appropriate (BD)  Route is appropriate (IV)  No Interaction with other Prescribed Drugs 
  20. 20. Artemether/Lumefantrine Prescribed for Treatment of Malaria  Dose is Accurate (80/480mg)  Frequency is appropriate  Route is appropriate (Oral)  No Interaction with other Prescribed Drugs 
  21. 21. Omeprazole Prescribed for Prophylaxis of Bed ridden ulcer  Dose is Accurate (40mg)  Frequency is appropriate (OD)  Route is appropriate (IV)  No Interaction with other Prescribed Drugs 
  22. 22. Metoclopramide Prescribed for Treating vomiting  Dose is Accurate (10mg)  Frequency is appropriate (q8h)  Route is appropriate (IV)  Increases Rate of Absorption of Acetaminophen 
  23. 23. Acetaminophen Prescribed for Treating Fever, Pain etc  Dose is Accurate (1gm)  Frequency is appropriate (q4 – 6hrs)  Route is appropriate (IV)  Rate of Absorption is increased by Metoclopramide 
  24. 24. Vitamin B Complex  Riboflavin (Vitamin B2):100mg  Thiamine HCl (Vitamin B1):100mg,  Cyanocobalamin:50mcg Prescribed for treating anemia  Dose is Accurate  Frequency is appropriate  Route is appropriate  No Interaction with other Prescribed Drugs 
  25. 25. THE DISEASE
  26. 26. Malaria  Malaria, one of the most widespread diseases, caused by Plasmodium Species  Transmitted by infected individuals via ◦ ◦ ◦ ◦ Mosquito Bite Blood transfusion, Congenitally, Infected needles by drug abusers
  27. 27. Types & Causative Agents
  28. 28. SYMPTOMS 29
  29. 29. Life Cycle of Plasmodium Two interdependent life cycles  Sexual cycle: occurs in the mosquito  Asexual cycle: occurs in the human ◦ Exo erythrocytic Phase ◦ Erythrocytic Phase 30
  30. 30. Life Cycle of Plasmodium 31
  31. 31. TREATMENT
  32. 32. MALIGNANT MALARIA
  33. 33. Quinine  Adult Oral Dose ◦ 600mg q 8 hrs for 5 – 7 days with or followed by      Doxycycline 200mg OD for 7days Or Clindamycin 450mg q 8 hrs for 7days Or if parasite is likely to be resistant Pyrimethamine 75mg / sulfadoxine 1.5g as a single dose
  34. 34. Quinine  Pediatric Dose – Oral ◦ 10mg/kg (Max 600mg) q 8 hrs for 7 days with or followed by     Clindamycin 7 – 13 mg/kg (Max 450mg) q 8 hrs for 7days Or Over 12 years Doxycycline 200mg OD for 7days Or if parasite is likely to be resistant use pyrimethamine & sulfadoxine combination Age Dose < 4 years Pyrimethamine 12.5mg / sulfadoxine 250mg 5–6 Pyrimethamine 25mg / sulfadoxine 500mg 7–9 Pyrimethamine 37.5mg / sulfadoxine 750mg 10 - 14 Pyrimethamine 50mg / sulfadoxine 1g
  35. 35. Quinine  Adult Parenteral Dose ◦ Loading Dose 20mg/kg (Max 1.4gm) infused IV for 4 hours every 8 hours ◦ Maintenance Dose 10mg/kg (max 700mg) infused IV for 4 hours every 8 hours  Pedriatric Dose – Parenteral ◦ Same as Adult adjusted according to weight
  36. 36. Alternative Treatment Atovaquone / Proguanil  Artemether / Lumefantrine 
  37. 37. Atovaquone / Proguanil  Adult Oral Dose ◦ 4 Standard Tablets Once Daily for 3 days  A standard tablet contains 100 mg of proguanil hydrochloride and 250 mg of atovaquone
  38. 38. Atovaquone / Proguanil  Pediatric Oral Dose Body Weight Dose > 40 kg Same as Adult Dose 5 – 8 kg 2 Pediatric Tablets OD for 3 days 9 – 10 kg 3 Pediatric Tablets OD for 3 days 11 – 20 kg 1 Standard Tablet OD for 3 days 21 – 30 kg 2 Standard Tablet OD for 3 days 31 – 40 kg 3 Standard Tablet OD for 3 days A pediatric tablet contains 25 mg of proguanil hydrochloride and 62.5 mg of atovaquone
  39. 39. Artemether / Lumefantrine  Adult Oral Dose ◦ 4 Standard Tablets initially followed by 5 more same doses at  8, 24, 36, 48 & 60 hours  A standard tablet contains 20 mg of Artemether and 120 mg of Lumefantrine
  40. 40. Artemether / Lumefantrine  Pediatric Dose – Oral Body Weight Dose > 35 kg (> 12yrs) Same as Adult Dose 5 – 15 kg 1 Tablet followed by 5 more doses at 8, 24, 36, 48 & 60 hours 15 – 25 kg 2 Tablet followed by 5 more doses at 8, 24, 36, 48 & 60 hours 25 – 35 kg 3 Tablet followed by 5 more doses at 8, 24, 36, 48 & 60 hours A standard tablet contains 20 mg of Artemether and 120 mg of Lumefantrine
  41. 41. Pregnanacy Falciparum Malaria is dangerous in Pregnancy specially in last trimester  Following are Safe  ◦ Quinine ◦ Clindamycin  Following should be avoided ◦ Doxycycline ◦ Atovaquone / Proguanil ◦ Artemether / Lumefantrine
  42. 42. Chloroquine is drug of choice in Benign Malaria BENIGN MALARIA
  43. 43. Chloroquine The adult dosage regimen for chloroquine by mouth is:  initial dose of 620 mg then  a single dose of 310 mg after 6 to 8 hours then  a single dose of 310 mg daily for 2 days  (approximate total cumulative dose of 25 mg/kg) 
  44. 44. Primaquine It is used for Radical Cure (Prevent Relapse) in the case of P. vivax & P. ovale  P. malariae  ◦ Not required  P. vivax ◦ 30 mg daily for 14 days following chloroquine  P. ovale ◦ 15 mg daily for 14 days following
  45. 45. Chloroquine in Pediatrics The dosage regimen is:  initial dose of 10 mg/kg (max. 620 mg) then  a single dose of 5 mg/kg (max. 310 mg) after 6–8 hours then  a single dose of 5 mg/kg (max. 310 mg) daily for 2 days 
  46. 46. Primaquine in Pediatrics Should not be given to children under 6 months without specialist advice  P. vivax  ◦ 500mcg / kg (Max 30 mg) daily for 14 days following chloroquine  P. ovale ◦ 250mcg / kg (Max 15 mg) daily for 14 days following chloroquine
  47. 47. Parenteral for Adult & Pediatrics  IV infusion of Quinine ◦ 10mg / kg (Max 700mg) for 4 hours every 8 hours
  48. 48. Pregnancy Chloroquine is safe  Primaquine should be avoided  instead chloroquine should be continued at a dose of 310 mg each week during the pregnancy. 
  49. 49. Chloroquine-resistant benign malaria  We use, ◦ Quinine ◦ Atovaquone / Proguanil ◦ Artemether / Lumefantrine
  50. 50. Prevention Avoid Mosquito Bite  Preventive Medicine  ◦ Varies area to area  In our region Chemoprophylaxis is not recommended
  51. 51. References BNF 61  www.cdc.gov/malaria  www.who.int/topics/malaria 

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