This document discusses the life cycle of malaria parasites and sites of action for antimalarial drugs. It provides information on different drug classes including aminoquinolones, antifolates, and artemisinin derivatives. It outlines treatment guidelines for Plasmodium vivax and Plasmodium falciparum malaria in Sri Lanka, including recommended drugs, dosages, and contraindications. The document also reviews chemoprophylaxis regimens for travelers, drug safety in pregnancy and breastfeeding, and notes specific information on the mechanism of action and adverse effects of chloroquine.

2. Life cycle of malaria parasite & sites of drug action
• Radical cure
• Causal prophylaxis
• Clinical cure
• Suppressive prophylaxis
Gametocidal

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. Drug safety
Pregnancy Breast Feeding
 Chloroquine ok ok
 Paludrine ok ok
 Mefloquine ok no
 Doxycycline no no
 Malarone no no

11. 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

12. Adverse effects
 Nausea
 Vomiting
 Anorexia
 Uncontrollable itching
 Epigastric pain
 Retinal toxicity