By Sanjay Gowda

1. TREATMENT OF FALCIPARUM MALARIA
SANJAY GOWDA
1

2. CONTENTS
• INTRODUCTION
• CLINICAL FEATURES
• INVESTIGATIONS
• TREATMENT OF UNCOMPLICATED F.MALARIA
• TREATMENT OF COMPLICATED F.MALARIA
• REFERENCE
2

3. INTRODUCTION
Malaria in man is caused by four distinct species of malaria parasite.They are:
P.vivax, P.falciparum, P.malariae and P.ovale.
In India about 50 percent of infections reported are due to P.falciparum and
4-8 percent are due to mixed infections and the rest due to P.vivax.
The malarial parasite undergoes 2 cycles of development-
-the human cycle(asexual cycle)
-the mosquito cycle(sexual cycle) occurs in infected female Anopheline mosquito.
3

4. CLINICAL FEATURES OF F.MALARIA
Fever- In F.malaria the primary fever in first few days is usually
irregular and then the classical 48 hr periodicity becomes established.
The typical attack consists of 3 distinct stages i.e.,
a) Cold stage : The onset is with lassitude,headache,nausea and chills
and rigors.Temperature rises rapidly to 39-41*c.This stage lasts for
¼-1 hr.
b) Hot stage : The patient feels burning hot and casts off his clothes.
The skin is hot and dry to touch.This stage lasts for 2-6 hrs.
4

5. CONTINUED…,
c) Sweating stage: Fever comes down with profuse sweating. The
temperature drops rapidly to normal and skin is cool and moist.
> In persons with poor immunity the paroxysms are associated
marked prostration and there is tendency to develop features of
complicated malaria.
5

6. FEATURES OF COMPLICATED F.MALARIA
Impaired consciousness/coma
Repeated generalized convulsions
Renal failure
Jaundice
Severe anaemia
Pulmonary oedema
Hypoglycaemia and metabolic acidosis
DIC
Haemoglobinuria,shock and death
6

7. INVESTIGATIONS
1) Microscopy: two types of blood films are prepared on a single
glass slide.They are:
a) Thin film: For species identification
b) Thick film: For detection and quantification of parasite.
2) Serological test: The malarial fluorescent antibody test. Useful
in epidemiological studies.
3) Rapid diagnostic test: Based on detection of circulating parasite
antigens with a simple dipstick format.
7

8. TREATMENT OF UNCOMPLICATED F.MALARIA
In other states (other than North-Eastern states):
1) Artemisinin based combination therapy (ACT-SP)*
Artesunate 4mg/kg b.w daily for 3 days, plus
Sulfadoxine(25 mg/kg b.w)- Pyrimethamine(1.25 mg/kg b.w)
on the first day.
* ACT is not given in 1st trimester of pregnancy.
2) Primaquine : 0.75 mg/kg b.w on day 2.
8

9. DOSAGE CHART WITH ACT-SP
9

10. In North-Eastern states (NE states):
1) ACT-AL co-formulated tablet of Artemether(20mg)-
-Lumefantrine(120mg)
(Not recommended during 1st trimester of pregnancy and children-
- less than 5kg).
2) Primaquine* : 0.75 mg/kg b.w on day 2.
10

11. DOSAGE CHART WITH ACT-AL
11

12. TREATMENT IN PREGNANCY
1st trimester: Quinine salt 10mg/kg 3 times daily for 7 days.
2nd and 3rd trimester: Area- specific ACT as per dosage schedule
given above i.e., ACT-AL in NE states and ACT-SP in other states.
12

13. TREATMENT OF MIXED INFECTIONS
(P.VIVAX + P.FALCIPARUM) CASES
In North Eastern states : Age specific ACT-AL for 3 days+Primaquine -
-0.25 mg/kg b.w daily for 14 days.
In other states: ACT-SP 3 days +Primaquine 0.25 mg/k.g b.w daily
for 14 days.
13

14. DOSAGE CHART FOR MIXED INFECTIONS
14

15. TREATMENT OF COMPLICATED F.MALARIA
Severe malaria is an emergency and treatment is given as per severity
and associated complications which can be best decide by treating
physicians.
Before admitting or referring patients, the attending doctor or
health worker should do RDT and take blood smear ,give a parenteral
dose of artemisinin derivative or quinine in suspected cerebral
malaria cases and send details of treatment history and blood
slide with the patient.
15

16. CHEMOPROPHYLAXIS FOR COMPLICATED MALARIA
16

17. REFERENCE
K.Park, Park textbook of Preventive and Social Medicine,
23rd e.d., Jabalpur, M/s Banarsidas Bhanot,p.g. no 255-267.
17

18. 18