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Malaria by affan ali(036)
- 2. Affan Ali Roll No.36 CASE STUDY
- 3. Demographics Name: Muhammad Ali Age: 21 Years Gender: Male Marital Status: Un Married Ward: Medicine Hospital: Dow University Hospital
- 4. History No Disease History Not on Medication
- 5. Present Complains Morning &Midnight High Grade Fever for 5days Chills for 5days Vomiting for 1 day Epigastric Pain Sweating Weakness
- 6. Laboratory Findings Haemoglobin •11.3g/dl RBCs • 3.7 x108/µl MCV • 93 fl MCH • 31 pg MCHC • 33% PCV • 34%
- 7. Laboratory Findings Total Leukocytes• 3.1 x103/µl Neutrophils • 29% Eosinophils • 1% Basophils • 0% Monocytes • 11% Lymphocytes • 59% Platelets • 95 x103/µl
- 8. Laboratory Findings Sodium • 140mEq/l Potassium • 3.4 mEq/l Chloride • 105 mEq/l Bicarbonate • 29 mEq/l Urea • 42.4mg/dl Sr. Creatinine • 0.9 mg/dl
- 9. Laboratory Findings Dengue IgG P. Falciparum P. Mix TyphiDot Negative Negative Positive Negative
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- 18. Others Dextrose Saline @100cc/hour Normal Saline @ 100 cc/hour
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- 20. Ceftriaxone Prescribed for Prophylaxisof 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
- 21. Artemether/Lumefantrine Prescribed for Treatmentof Malaria Dose is Accurate (80/480mg) Frequency is appropriate Route is appropriate (Oral) No Interaction with other Prescribed Drugs
- 22. Omeprazole Prescribed for Prophylaxisof Bed ridden ulcer Dose is Accurate (40mg) Frequency is appropriate (OD) Route is appropriate (IV) No Interaction with other Prescribed Drugs
- 23. Metoclopramide Prescribed for Treatingvomiting Dose is Accurate (10mg) Frequency is appropriate (q8h) Route is appropriate (IV) Increases Rate of Absorption of Acetaminophen
- 24. Acetaminophen Prescribed for TreatingFever, Pain etc Dose is Accurate (1gm) Frequency is appropriate (q4 – 6hrs) Route is appropriate (IV) Rate of Absorption is increased by Metoclopramide
- 25. 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
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- 27. Malaria Malaria, one ofthe most widespread diseases, caused by Plasmodium Species Transmitted by infected individuals via ◦ ◦ ◦ ◦ Mosquito Bite Blood transfusion, Congenitally, Infected needles by drug abusers
- 28. Types & CausativeAgents
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- 30. Life Cycle ofPlasmodium Two interdependent life cycles Sexual cycle: occurs in the mosquito Asexual cycle: occurs in the human ◦ Exo erythrocytic Phase ◦ Erythrocytic Phase 30
- 31. Life Cycle ofPlasmodium 31
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- 34. 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
- 35. 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
- 36. 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
- 37. Alternative Treatment Atovaquone /Proguanil Artemether / Lumefantrine
- 38. Atovaquone / Proguanil AdultOral Dose ◦ 4 Standard Tablets Once Daily for 3 days A standard tablet contains 100 mg of proguanil hydrochloride and 250 mg of atovaquone
- 39. Atovaquone / Proguanil PediatricOral 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
- 40. Artemether / Lumefantrine AdultOral 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
- 41. Artemether / Lumefantrine PediatricDose – 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
- 42. Pregnanacy Falciparum Malaria isdangerous in Pregnancy specially in last trimester Following are Safe ◦ Quinine ◦ Clindamycin Following should be avoided ◦ Doxycycline ◦ Atovaquone / Proguanil ◦ Artemether / Lumefantrine
- 43. Chloroquine is drugof choice in Benign Malaria BENIGN MALARIA
- 44. Chloroquine The adult dosageregimen 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)
- 45. Primaquine It is usedfor 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
- 46. Chloroquine in Pediatrics Thedosage 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
- 47. Primaquine in Pediatrics Shouldnot 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
- 48. Parenteral for Adult& Pediatrics IV infusion of Quinine ◦ 10mg / kg (Max 700mg) for 4 hours every 8 hours
- 49. Pregnancy Chloroquine is safe Primaquine should be avoided instead chloroquine should be continued at a dose of 310 mg each week during the pregnancy.
- 50. Chloroquine-resistant benign malaria We use, ◦Quinine ◦ Atovaquone / Proguanil ◦ Artemether / Lumefantrine
- 51. Prevention Avoid Mosquito Bite Preventive Medicine ◦ Varies area to area In our region Chemoprophylaxis is not recommended
- 52. References BNF 61 www.cdc.gov/malaria www.who.int/topics/malaria