Direct microscopy is the gold standard for investigating malaria. Various serological and molecular tests can also be used to identify the malaria parasite and species. For uncomplicated malaria caused by Plasmodium vivax, P. malariae, P. ovale, or chloroquine-sensitive P. falciparum, treatment options include chloroquine or amodiaquine. For P. vivax and P. ovale infections, primaquine is also given to prevent relapses. Multidrug-resistant P. falciparum is treated with artemisinin combination therapy. For severe P. falciparum malaria, parenteral artesunate, artemether or quinine can be given

1. MANAGEMENT
OF
MALARIA
BY:-
K AGASYA RAJ

2. INVESTIGATIO
N
DIRECT
MICROSCOP
Y
FLOURESCE
NT STAINING
QBC
DETECTION OF
ANTIGEN
SEROLOGICAL
TEST
THICK THIN
USED FOR
RAPID
STAINING
AND RAPID
SCREENIN
GOF
SMEARS
TO
IDENTIFY
MALARIAL
PARASITE
ENZYME
IMMUNOASSA
Y TEST
1. ELISA
2. RIA
3. IIT
4. PCR
PARASI
TE
IDENTIF
-
ICATION
SPECIE
S
IDENTIF
I-
CATION
OptiMAL-IT
*DIRECT MICROSCOPY IS THE “GOLD STANDARD” IN INVESTIGATION
OF MALARIA.

3. Uncomplicated malaria Regimen(s)
Known chloroquine-sensitive strains of P. vivax, P.malariae, P. ovale, P.
falciparum
Chloroquine (CQ): 10 mg of base/kg stat followed by 5 mg/kg at 12, 24 and 36 h or by 10
mg/kg at 24 h & 5 mg/kg at 48h
OR
Amodiaquine (10-12 mg of base/kg qd for 3 days
Radical treatment for P. vivax & P. ovale In addition to chloroquine or amodiaquine, primaquine (PQ): 0.25 mg of base/kg once
daily with food for 14 days to prevent relapses. In Oceania and South-East Asia:
primaquine dose is 0.5 mg/kg body weight.
In mild G6PD deficiency, 0.75 mg of base/ kg should be given once weekly for 8 weeks.
PQ should not be given in severe G6PD deficiency.
NON Multidrug-resistant (MDR) P. falciparum malaria (Artemisinin combination therapy) ACT-
SP: Artesunate (4 mg/kg/day OD for 3 days) plus sulfadoxine (25 mg/kg)/
pyrimethamine (1.25 mg/kg) as a single dose on day 1
OR
Artesunate (4 mg/kg/day for 3 days) plus amodiaquine(10 mg/kg/day OD for 3 days)
Multidrug-resistant P.
falciparum malaria
ACT-AL: Artemether-lumefantrine (1.7/12 mg/kg body weight, respectively, per dose,
given twice a day for 3 days with food)
OR
Artesunate (4 mg/kg/day OD for 3 days) plus
Mefloquine (25 mg/Kg- either 8.3 mg/kg/ day OD for 3 days or 15 mg/kg on day 2 and
then 10 mg/kg on day 3)

4. Currently, there are four artemisinin compounds that have been recommended by The
National Vector Borne Disease Control Program for severe P. falciparum malaria. For
treatment initiation, any one of the following four can be used:-
1. Artesunate: 2.4 mg/kg i.v. or i.m. given on admission (time=0), then at 12 h and 24 h,
then once a day.
2. Artemether: 3.2 mg/kg i.m. given on admission then 1.6 mg/kg per day.
3. Arteether: 150 mg daily i.m for 3 days in adults only (not recommended for children)
4. Quinine: 20 mg quinine salt/kg body weight on admission (IV infusion in 5%-10%
Dextrose) followed by maintenance dose of 10 mg/kg 8 hourly; infusion rate not to exceed
5 mg/kg per hour. Loading dose is omitted if the patient has already received quinine.
Once the patient can accept, any one of the following three options can be used by the
oral route for 7 days:-
1. Artemisinin Combination Therapy (ACT) specific (ACT+Lumefantrine) for 3
consecutive days. Primaquin single dose given on day 2.
2. ACT-Sulfadoxine Pyramethamine for 3 consecutive days and Primaquin single dose
given on day 2. This regimen is not to be given for treatment of malaria in Northeastern
states.
3. In those treated with parenteral Quinine, continue with oral Quinine 10mg/Kg every 8
hourly along with either Doxycycline 100 mg daily. Alternatively Clindamycin 10 mg/Kg

7. MALARIA CONTROL
• Indoor residual spraying.
• Insecticide treated bed nets.
• Electronic mosquito repellants.
• Intermittent preventive therapy.