Management of resistant malaria and it's chemo prophylaxis

1. Presented by:
Sumit Sharma
BPKIHS
RESISTANT MALARIA
Management and Chemoprophylaxis

2. • Drugs used in resistant Malaria
• Treatment Regimes
• Chemoprophylaxis of Malaria
OBJECTIVES:

3. • If not otherwise specified-malaria in which there is chloroquine
resistant due to P. falciparum is called resistant malaria.
Multi drug Resistance (MDR):
Resistance against chloroquine plus any other antimalarial drug.
Border of south east country Thailand is multidrug resistant.
RESISTANT MALARIA:

4. A. P. falciparum resistance
1. Chloroquine resistance strains:
In all areas of chloroquine use from central America, South
America, Africa, Asia, TROPICAL ZONE
2. Reistance to folate antagonists and sulfonamides
common for P. falciparum and less common for P. vivax
B. P. vivax resistance:
reported in Indonesia, Brazil, Colombia
C. P. ovale and P. malariae Resistance:
no resistance to chloroquine
Drug Resistance also seen in Mefloquine, Primaquine, Quinine,
Halofantrine
GLOBAL SCENARIO OF DRUG RESISTANCE

7. Development of Resistance:
Increased
transmission
Extensive
use
Inadequate
dosage
Poor
compliance
Immune
status
Inadequate
treatment
Resistance

8. 1. Efflux of drug by and active glycoprotein pump
decreases chloroquine in vacuoles
decrease drug effects
Reason: Mutation in chloroquine resistance promoter gene( PfCRT): codes for
transporter molecules
2. Inhibition of binding of chloroquine with Haeme( toxin)
More formation of Hemozoin
Some drugs Verapamil, Desipramine may reverse this resistance by inhibiting the pump itself.
Mechanism of Resistance?

9.  Resistant to chloroquine
 Artemisinin derivatives (Artesunate, Artemether, dihydroartemisinin) first
line drug
 Sulfadoxine-Pyrimethamine (fansidar)
 Mefloquine
 Lumefantrine
 Quinine + Doxycycline
 Proguanil
Drugs for resistant P.falciparum

10. • Uncomplicated infection:
Coartem (artemether 20mg + lumefantrine 120mg) 4 tablets, 2 times
daily for 3 days.
T/t regimens (for chloroquine resistant falciparum
malaria)

11. Other WHO recommendations:

12. Other Drugs Used:

13. • Short Plasma half life of
artermisinin led to unacceptably
high recrudescence rates. This was
reversed by combination of longer
acting drugs
• Prevents artemisinin resistance
Why combination Therapy?

14. • Complicated infection:
Inj artesunate 2.4mg/kg
Every 12 hrs on first day and daily for next 2 days
1 vial= 60mg
Switchover to 3 day oral ACT in between whenever the patient can take
and tolerate oral medications.
To prevent recrudescence add 7 day doxycycline 100mg BD or
clindamycin 300mg QID
Alternative to Artesunate: Quinine ( used in Pregnancy as first choice)
T/t regimens (for chloroquine resistant falciparum
malaria) contd..

15. Aims
 to prevent the attack of malaria
 to reduce human reservoir of infection
Chemoprophylaxis includes:
i. Causal prophylaxis
Pre-erythrocytic phase targeted.
primaquine- 0.5mg/kg OD
ii. Suppressive prophylaxis
Erythrocytic phase targeted
chloroquine, mefloquine, artemisinin, etc
Chemoprophylaxis:

16. Travellers

17. New strategy for Malaria control
given to pregnant women and children
Fansidar( sulfadoxine and pyremethamine).
Intermittent prophylaxis

18. Pregnant women:
 Start prophylaxis after 1st trimester and continue till 1 month after delivery
 Drug of choice: Fansidar(pyremethamine and sulfadoxine) during second and
third trimester of pregnancy
 Chloroquine and mefloquine can also be used
 Drug contraindicated:
• Doxycycline, Primaquine, Halofantrine.
• These drugs cause hemolysis, hemoglobinuria and hypoglycemia in pregnancy
pregnancy

19. • Fansidar
• Monthly doses during transmission season
• During scheduled immunization
Children

21. • Defn Resistant malaria, MDR
• Drugs for resistant malaria:
-chloroquine resistant
• Treatment Regimes:
-complicated and uncomplicated
• Chemoprophylaxis:
-Travelers, children, Pregnant
Summary and Focus points:

22. REFRENCES
1. Basic & clinical pharmacology, Betram G. Katzang
2. Essentials of Pharmacology, K.D.Tripathi
3. Video lectures and personal guidance by Dr. Dipesh Raj Pandey
4. www.cdc.gov
5. www.sciencedirect.com
6. www.microbewiki.Kenyon.edu

23. - DALAI LAMA 