The document provides guidelines for the diagnosis and treatment of malaria in India. It outlines recommended treatment schedules for uncomplicated malaria caused by P. vivax and P. falciparum, including chloroquine regimens and primaquine dosages. For P. falciparum, the preferred treatment in certain high endemic areas is artemisinin combination therapy (ACT) using artemether-lumefantrine. The guidelines also describe the clinical features and specific antimalarial treatments recommended for severe malaria cases, such as intravenous artesunate or quinine.

1. GUIDELINES FOR
DIAGNOSIS AND
TREATMENT OF
MALARIA IN INDIA
BY:
Dr. AYESHA SARWAR.

2. ACCORDING TO THE REVISED
DRUG POLICY, THERE IS NO
SCOPE OF PRESUMPTIVE
TREATMENT IN MALARIA
CONTROL.
THE RECOMMENDED GUIDELINES
ARE DISCUSSED UNDER
FOLLOWING 2 HEADINGS:
 Treatment of uncomplicated
malaria.
 Treatment of severe malaria.

4. All fever cases diagnosed as malaria by
microscopy or RDT should promptly be
given effective treatment.

6. RECOMMENDED TREATMENT
SCHEDULE

7. 1.CHLOROQUINE FOR P.VIVAX &
P.FALCIPARUM
AGE in
years
DAY 1
(10mg/kg)
DAY 2
(10mg/kg)
DAY 3
(5mg/kg)
<1
½
½
1/4
1-4
1
1
½
5-8
2
2
1
9-14
3
3
1½
15 &above
4
4
2

8. 2.PRIMAQUINE FOR P.VIVAX (DAILY
DOSAGE FOR 14DAYS)
AGE(in years)
<1
DAILY DOSAGE NO. OF
in mg base
TABLETS
(2.5 mg base)
Nil
Nil
1-4
2.5
1
5-8
5
2
9-14
10
4
15&above
15
6

9. 3.PRIMAQUINE FOR P.FALCIPARUM
(SINGLE DOSE ON FIRST DAY)
AGE in
years
DOSAGE
(in mg
base)
<1
Nil
NO. OF
TABLETS
(7.5mg
base)
0
1-4
7.5
1
5-8
15
2
9-14
30
4
15 &above 45
6

10. THERAPY (ACTARTESUNATE+SULFADOXINE+PYRIMETHAMINE
) FOR P.FALCIPARUM
AGE in
years
<1
AS
NO. OF
NO. OF
TABLETS
TABLETS
ON 1ST DAY ON 2ND
DAY
½
½
¼
Nil
NO. OF
TABLETS
ON 3RD
DAY
½
Nil
SP
1-4
AS
1
1
1
Nil
1
Nil
SP
5-8
2
2
2

11. AREAS THAT QUALIFY FOR THE
ACT:
 THEY
ARE THE LISTED AREAS WITH
HIGH P.falciparum ENDEMICITY IN
SEVEN NORTH EASTERN
STATES, AP, CHATTISGARH, JHARKHAN
D, MP & ORISSA.
 117 DISTRICTS HAVE BEEN IDENTIFIED
FOR THE ACT.
 THE INDIVIDUALS WHO QUALIFY FOR
THE ACT ARE:
A. THE PATIENTS WITH HISTORY OF
TRAVEL TO THE LISTED AREAS

12. GENERAL RECOMMENDATIONS FOR
THE MANAGEMENT OF
UNCOMPLICATED MALARIA.
 AVOID
STARTING TREATMENT ON AN
EMPTY STOMACH.
 THE FIRST DOSE SHOULD BE GIVEN
UNDER OBSERVATION.
 DOSE SHOULD BE REPEATED IF
VOMITING OCCURS WITHIN 30minutes.
 THE PATIENT SHOULD REPORT BACK IF
THERE IS NO IMPROVEMENT AFTER
48hrs.
 THE PATIENT SHOULD ALSO BE
EXAMINED FOR CONCOMITANT

13. B] TREATMENT OF
SEVERE MALARIA.

14. CLINICAL FEATURES:
IMPAIRED CONSIOUSNESS/COMA &
GENERALIZED CONVULSIONS.
 RENAL FAILURE (serum creatinine>3mg/dl)
 JAUNDICE (serum bilirubin>3mg/dl)
 SEVERE ANEMIA(Hb< 5g/dl)
 PULMONARY EDEMA/ ACUTE RESPIRATORY
DISTRESS SYNDROME
 HYPOGLYCEMIA(plasma glucose<40 mg/dl).
 METABOLIC ACIDOSIS
 SHOCK(systolic BP<80mmHg)
 ABNOMAL BLEEDING & DIC
 HEMOGLOBINURIA
 HYPERTHERMIA.


15. SPECIFIC ANTIMALARIAL
TREATMENT OF SEVERE MALARIA
1] ARTESUNATE:
2.4 mg/kg i.v or i.m..given on admission
time, then at 12hrs and 24hrs, then once
a day.
(care should be taken to dilute artesunate
with 5% sodium bicarbonate provided in
the pack)
2] QUININE:
20mg/kg i.v on admission followed by
maintainance dose of 10mg/kg 8hrly.
(never give bolus injection of quinine)