SImplified Malaria overview for practising pediatricians in India - north india more specifically with a low incidence of malaria. By Dr Gaurav Gupta MD Pediatrician, Charak Clinics, Mohali, Chandigarh

1. Malaria – Filling in the blanks ! Dr Gaurav Gupta MAAP, MIAP, DCH, DNB Charak Clinics, Mohali

6. India – 15,24,939 / 49 % 593/5 377/3 1650/23 42991/199 2006 cases/ p fl 253/0 694/6 Delhi 347/6 157/6 Chandigarh 2494/38 250/18 Punjab 35683/1397 936/41 Haryana 2008 cases/ p fl 2002 cases/ p fl State/Yr

11. Diagnosis - RDT

15. Hold the third finger of the left hand and wipe its tip with spirit/Savlon swab; allow to dry Prick the finger with disposable needle/lancet; allow the blood to ooze out Take a clean glass slide. Take 3 drops of blood 1 cm from the edge of the slide, take another drop of blood one cm from the first drop of blood

16. Take another clean slide with smooth edges and use it as a spreader ...and make thick and thin smears. Allow it to dry Prepared smear. Slide number can be marked on the thin smear with a lead pencil.)

18. Avoid in seizures, cardiac disease. Do NOT use with Quinine. Do NOT re-treat with Mefloquine 25 mg/kg in 1-2 divided dose Mefloquine (250mg base Tablet) (LARIMEF, MEFLOTAS, MEFLOC, MQF) Quinine (300/600mg Base tab, 300mg/ml Inj) (CINKONA, KWINIL, QUININE) Chloroquine (PO/IV) (150 mg Base/ Tablet Syp 50 mg/ 5ml Base) (LARIAGO, CLOQUIN, NIVAQUINE P) Oral - 10 mg/kg 8 hourly for 4 days and 5 mg/kg 8 hourly for 3 days. IV - 16 mg of base/kg in 10 ml/kg NS/5% dextrose over 4 hours, then 8 mg of salt/kg over 4 hours, every 8 hours for 5-7 days. Oral - 10 mg/kg stat and 5 mg/kg * 3 doses over next 48 hours DoC for P Falciparum Oral – Uncomplicated IV – Complicated/ Cerebral Malaria IM Not recommended DoC for P Vivax (uncomplicated)

19. Other drugs include Tetracyclines, Proguanil, Halofantrine, Lumefantrine, Mepacrine, Bulaquine, clindamycin etc. Avoid with Quinine/ Mefloquine, in severe G6PD Deficient pt. To be used in ALL cases of Malaria Oral - 0.25mg/kg/day (once a day) for 14 days in P. vivax; 0.75 mg/kg as single dose in P. falciparum Primaquine tablets containing 2.5, 7.5 and 15 mg (PMQ-INGA) Avoid in Sulfa allergy Add-on therapy for CQR malaria (never alone) Oral – 1.25 mg /kg of Pyrimethamine Sulphadoxime/ Pyrimethamine (S/P) (500 mg / 25 mg) (LARIDOX, PYRALFIN, METAKELFIN, REZIZ)

20. May cause LFTs rise. 3.2mg/kg as loading dose, followed by 1.6mg/kg daily, until patient is able to swallow or for 5 days. Artemether (80 mg/ml Inj. and 40 mg cap) (LARITHER, MALITHER) Well tolerated 3 mg/kg OD for 3 days Arteether (150mg/ 2ml Inj, 50 mg tablet) (FALCIGUARD, RAPITHER, MALIJET, ARTISUN) Recommended for Severe Falciparum Malaria, as combination therapy IM/IV 2.4 mg/kg LD, followed by 1.2 mg/kg for 7 days Oral- 4 mg/kg on the first day followed by 2mg/kg for 6 days Artesunate (60 mg/ml Inj, 50 mg tablet) (FALCIGO, FALCIQUIN, FALCICARE, ARTISIN)

30. Other drugs that maybe used for prophylaxis include Doxycycline & Malarone (Atovaquone + Proguanil) Start 2-3 weeks before, continue during exposure and for 4 weeks thereafter 250 mg base once weekly 5mg/kg once weekly Mefloquine ((Tablet with 250mg base, 274mg salt) 200 mg Daily < 2yr – 50 mg / day 2-6 yr – 100 mg/day 7-9 yr – 150 mg/day > 9 yr – 200 mg/day 300 mg Once weekly 5 mg/kg weekly Start 1-2 days before, continue during exposure and for 4 weeks thereafter Proguanil Start one week before exposure, continue during exposure and for 4 weeks thereafter Chloroquine (150 mg Base/ Tablet Syp 50 mg/ 5ml Base)