6 Treatmentmalaria Final

2,006 views

Published on

Published in: Health & Medicine
1 Comment
0 Likes
Statistics
Notes
  • Be the first to like this

No Downloads
Views
Total views
2,006
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
114
Comments
1
Likes
0
Embeds 0
No embeds

No notes for slide

6 Treatmentmalaria Final

  1. 2. Control of malaria
  2. 3. MANAGEMENT OF MALARIA CASES: <ul><li>FIRST PRIORITY </li></ul><ul><li>-CLINICAL MANAGEMENT FOR MORBIDITY, MORTALITY REDUCTION </li></ul><ul><li>ROLE OF PHCs: </li></ul>HEALTH GUIDES,MULTI PURPOSE WORKERS TRAINED TO DETECT CASES DRUG DISTRIBUTION CENTRES,FEVER TREATMENT DEPOTS TREATMENT OF MALARIA
  3. 4. MANAGEMENT:
  4. 5. LARGE HOSPITAL: <ul><li>ideally should have the following facilities: </li></ul><ul><li>Round-the-clock coverage by qualified doctors and nurses </li></ul><ul><li>Facilities for intravenous infusion and central venous monitoring </li></ul><ul><li>Microscopy and rapid diagnostic test </li></ul><ul><li>Routine blood, urine,stool, biochemical tests </li></ul><ul><li>Blood transfusion </li></ul>
  5. 6. <ul><li>Oxygen therapy and ventilatory support </li></ul><ul><li>Facilities for doing a lumbar puncture </li></ul><ul><li>Facilities for specialized biochemical, radiological,microbiological tests </li></ul><ul><li>Facilities for intensive care management of critically illpatients </li></ul><ul><li>Facility for peritoneal/haemodialysis </li></ul>
  6. 7. SMALL HOSPITALS: <ul><li>Small hospitals/health facilities are likely to have fewer than 50 beds. </li></ul><ul><li>Laboratory facilities are minimal </li></ul><ul><li>Oxygen is generally not available </li></ul><ul><li>blood transfusion facility may not be available. </li></ul><ul><li>Referral of patients with severe malaria is advised. </li></ul>
  7. 8. BEFORE REFERAL: <ul><li>PRE-REFERAL TREATMENT </li></ul><ul><li>PREPARE REFERAL CARD </li></ul><ul><li>ADVICE TO ATTENDANT </li></ul><ul><li>WHEN TRANSFERING: </li></ul><ul><li>MAINTAIN A,B,C </li></ul><ul><li>INSERT URINARY CATHETER IF NEEDED </li></ul><ul><li>START ANTI-MALARIAL THERAPY </li></ul>
  8. 9. REFERAL NOT POSSIBLE: <ul><li>FIRST AID </li></ul><ul><li>I.V FLUIDS </li></ul><ul><li>SPECIFIC ANTI-MALARIAL TREATMENT </li></ul><ul><li>SUPPORTIVE MANAGEMENT </li></ul>
  9. 10. DISEASE CONTROL STRATEGIES <ul><li>CASE DETECTION </li></ul><ul><li>TREATMENT </li></ul><ul><li>MASS DRUG ADMINISTRATION </li></ul><ul><li>CHEMOPROPHYLAXIS </li></ul>
  10. 11. CASE DETECTION: <ul><li>ADULTS: </li></ul><ul><li>NATIONAL DRUG POLICY ON MALARIA,2008 ALL FEVER CASES INVESTIGATED FOR MALARIA </li></ul><ul><li>USING MICROSCOPY & RAPID DIAGNOSTIC KIT. </li></ul><ul><li>FIRST LINE:CHLOROQUINE </li></ul><ul><li>RESISTANT:ACT (ARTESUNATE+SULPHADOXINE+PYRIMETHAMINE) </li></ul><ul><li>CHILDREN: </li></ul><ul><li>CLASSIFY BASED ON SIGNS&SYMPTOMS ,RISK CATEGORY OF THE AREA….. </li></ul>
  11. 12. ADULTS: <ul><li>CLINICAL MALARIA: </li></ul><ul><li>IF RAPID DIAGNOSTIC KIT USED FOR P.FALCIPARUM ONLY,NEGATIVE CASES SHOWING SIGNS AND SYMPTOMS OF MALARIA WITHOUT ANY OBVIOUS CAUSE- CLINICAL MALARIA </li></ul><ul><li>DIAGNOSIS WITH MICROSCOPY,RDK NOT POSSIBLE,CASE WITH SIGNS & SYMPTOMS OF MALARIA – CLINICAL MALARIA </li></ul>
  12. 13. CHILDREN: VERY SEVERE FEBRILE DISEASE: <ul><li>FEVER + ANY GENERAL DANGER SIGNS OR STIFF NECK </li></ul><ul><li>-CLASSIFY AS VERY SEVERE FEBRILE DISEASE </li></ul><ul><li>-URGENT REFERAL + PRE REFERAL TREATMENT WITH ANTIBIOTICS </li></ul><ul><li>NOTE: IN AREAS WHERE P.FALCIPARUM PRESENT- PRE REFERAL DOSE OF I.M. QUININE GIVEN </li></ul>
  13. 14. HIGH RISK AREA: <ul><li>FEVER + NO GENERAL DANGER SIGNS OR STIFF NECK- MALARIA </li></ul><ul><li>TREATMENT JUSTIFICATION: </li></ul><ul><li>HIGH RATE OF MALARIA RISK IN AREA </li></ul><ul><li>POSSIBILITY OF ANOTHER ILLNESS CAUSING MALARIA TO PROGRESS </li></ul>
  14. 15. LOW MALARIA RISK AREA: <ul><li>FEVER + NO GENERAL DANGER SIGNS + NO MEASLES +NO OTHER CAUSE OF FEVER - MALARIA </li></ul><ul><li>RUNNY NOSE PRESENT OR MEASLES PRESENT - FEVER MALARIA UNLIKELY </li></ul>
  15. 16. TREATMENT: <ul><li>NATIONAL MALARIA CONTROL PROGRAMME(1953-58) </li></ul><ul><li>-ANTI MALARIALS HAD LITTLE ROLE </li></ul><ul><li>NATIONAL MALARIA ERADICATING PROGRAMME(1958-TILL DATE) </li></ul><ul><li>-THEY HAVE AN IMMENSE ROLE </li></ul>
  16. 18. UNCOMPLICATED MALARIA- CHLOROQUINE: <ul><li>ALL SUSPECTED,CLINICAL MALARIA CASES: </li></ul>
  17. 19. PRIMAQUINE:
  18. 20. CHLOROQUINE: EACH TAB CONTAINS 150MG(BASE) AGE(YRS) DAY 1 DAY 2 DAY 3 <1 ½ ½ ¼ 1-4 1 1 ½ 5-8 2 2 1 9-14 3 3 1 ½ >15 4 4 2
  19. 21. PRIMAQUINE- P.FALCIPARUM GIVEN AS SINGLE DOSE ON DAY ONE AGE(YRS) MG BASE NO OF TABLETS <1 - - 1-4 7.5 1 5-8 15 2 9-14 30 4 >15 45 6
  20. 22. PRIMAQUINE- P.VIVAX GIVEN FOR 14 DAYS AGE(YRS) MG BASE NO OF TABLETS <1 - - 1-4 2-5 1 5-8 5 2 9-14 10 4 >15 15 6
  21. 23. ACT:ARTESUNATE+ SUFADOXINE/PYRIMETHAMINE EACH TAB OF: ARTESUNATE CONTAINS 50MG ARTESUNATE S/P CONTAINS 500MG SULFADOXINE+ 25MG PYRIMETHAMINE NOT RECOMMENDED IN PREGNANCY OTHER COMBINATIONS:ATRESUNATE+MEFLOQUINE ARTEMETHER+LUMEFANTRINE AGE(YRS) DAY 1 DAY 2 DAY 3 <1 ½+ ¼ ½ +- ½ +- 1-4 1 + 1 1+- 1+- 5-8 2+1 ½ 2+- 2+- 9-14 3+2 3+- 3+- >15 4+3 4+- 4+-
  22. 24. NO RDK,MICROSCOPY AVAILABLE: LOW RISK AREA
  23. 25. NO RDK,MICROSCOPY AVAILABLE:HIGH RISK AREA:
  24. 26. SEVERE COMPLICATED CASES: <ul><li>I.V.QUININE – 10MG/KG B.WT IN 5% DEXTROSE SALINE OVER 4 HOURS, 8 HOURLY </li></ul><ul><li>SWITCH TO ORAL DOSE AS SOON AS POSSIBLE </li></ul><ul><li>TOTAL DURATION OF TREATMENT = 7 DAYS </li></ul><ul><li>INJ.ARTESUNATE CAN BE USED IN ADULTS,NON PREGNANT WOMEN </li></ul><ul><li>ARTESUNATE 2.4 MG/KG B.WT I.M/I.V FOLLOWED BY 1.2MG/KG B.WT AFTER 12HRS THEN,1.2MG/KG B.WT AFTER 4 HOURS </li></ul>
  25. 27. NOTE: <ul><li>SULFADOXINE/PYRIMETHAMINE NOT USEFUL IN VIVAX MALARIA </li></ul><ul><li>PRIMAQUINE CONTRA INDICATED IN PREGNANT WOMEN,INFANTS,G-6-P-D DEFICIENCY </li></ul><ul><li>ACT NOT USEFUL IN VIVAX MALARIA. </li></ul><ul><li>ACT SHOULD BE GIVEN ONLY TO CONFIRMED P.FALCIPARUM MALARIA CASES. </li></ul>
  26. 28. TOXIC HAZARDS OF DRUGS: <ul><li>CHLOROQUINE: </li></ul><ul><li>NAUSEA,VOMITTING,HEADACHE,BLURRING VISION,RETINAL DAMAGE(LONG TERM USE) </li></ul><ul><li>PRIMAQUINE: </li></ul><ul><li>GI EFFECTS,CNS,HEMOLYSIS(CVS) IN G-6-PD DEFICIENT PEOPLE </li></ul><ul><li>-stop primaquine immediately if he develops symptoms like dark </li></ul><ul><li>coloured urine, yellow conjunctiva, bluish discolouration of lips, </li></ul><ul><li>abdominal pain, nausea, vomiting etc. and should report to the </li></ul><ul><li>doctor immediately </li></ul>
  27. 30. DISEASE CONTROL STRATEGIES <ul><li>CASE DETECTION </li></ul><ul><li>TREATMENT </li></ul><ul><li>MASS DRUG ADMINISTRATION </li></ul><ul><li>CHEMOPROPHYLAXIS </li></ul>
  28. 31. MASS DRUG ADMINISTRATION <ul><li>WHO REVISED STRATEGY: </li></ul><ul><li>IT IS RECOMMENDED IN HIGHLY ENDEMIC AREAS FOR CURBING TRANSMISSION+EXTENSIVE ANTIMOSQUITO MEASURES </li></ul><ul><li>MASS DRUG ADMINISTRATION IN CHILDREN <5YRS NOT RECOMMENDED : </li></ul><ul><li>MAY INTEFERE WITH DEVELOPMENT OF PROTECTIVE IMMUNITY </li></ul><ul><li>ACCLERATE DRUG RESISTANCE </li></ul><ul><li>SCARCE RESOURSES MAY BE BETTER USED FOR TREATMENT </li></ul><ul><li>RISK OF RETINOPATHY </li></ul>
  29. 32. CHEMOPROPHYLAXIS <ul><li>RECOMMENDED FOR </li></ul><ul><li>TRAVELLERS FROM NON ENDEMIC AREAS </li></ul><ul><li>SHORT TERM FOR SOLDIERS,POLICE FORCE,LABOUR FORCES DURING WORK IN ENDEMIC AREAS </li></ul><ul><li>PREGNANT WOMEN IN AREAS OF HIGH TRANSMISSION(BUT PROMPT TREATMENT OF CLINICAL EPISODES RECOMMENDED) </li></ul><ul><li>COMPLEMENT WITH PERSONAL PROTECTION </li></ul>
  30. 33. <ul><li>SHOULD BEGIN 1 WEEK BEFORE ARRIVAL IN MALARIOUS AREA,CONTINUED 4 WEEKS AFTER LEAVING THE AREA. </li></ul><ul><li>SIDE EFECTS OF CHLOROQUINE WITH LONG USE- </li></ul><ul><li>300MG WEEKLY FOR 5 YRS SCREEN TWICE YRLY FOR RETINAL CHANGES </li></ul><ul><li>100MG DAILY DOSE – START SCREENING AFTER 3 YRS </li></ul>
  31. 34. CHEMOPROPHYLAXIS: DRUG THERAPEUTIC DOSE PROPHYLAXIS CHLOROQUINE 100/150 MG BASE 300MG PROGUANIL 100 MG 200MG 2 TAB OD MEFLOQUINE 250 MG 250MG 1/WEEK(SAME ADY EACH WEEK DOXYCYCLINE 100 MG 100MG 1 CAP OD

×