Malaria treatment

Uncomplicated malaria 

Plasmodium vivax:

Chloroquine ( larigo 250mg , larigo ds 500mg)

Day 0: 10mg/kg stat

Day 1: 10mg/kg stat

Day 2: 5mg/kg stat

+

Primaquine ( malirid  2.5mg, 5mg) - not malarid

0.25mg/kg OD * 14 Days

(Avoid in G6PD, Infants, Pregnancy.)

Plasmodium falciparum:

  • Falcigo sp kit ( artesunate 200; sulfadoxine 500; pyrimathamine 25mg i.e for a 20kg child 1 kit) 
    • artesunate 4 mg/kg OD * 3 days 
    • sulfadoxine (25 mg/kg) -pyrimethamine (1.25) on Day 0
+

  • Primaquine ( malirid 2.5mg, 5mg)- not malarid

0.75mg/kg stat * 2nd  Day

(Avoid in G6PD, Infants, Pregnancy.)

 Or

  •  Lumirax ( aretemether+ lumefantrene (20+120 , 40+240, 60+360, 80/480) syp 20+120/5ml)
    •  5-14kg /  yr : lumerax 40 1 BD * 3 days
    • 15-24kg /  yr: lumerax 80 1 BD * 3 days
    • 25-34kg /  yr: lumerax 60 2 BD * 3 days
    •    >34kg /  yr: lumerax 80 2 BD * 3 days
+

  • Primaquine ( malirid 2.5mg, 5mg, 7.5mg, 15mg, 45mg)- not malarid

0.75mg/kg stat * 2nd  Day

(Avoid in G6PD, Infants, Pregnancy.)

Mixed infections: 

Same as falciparum malaria but primaquine for 14 days

Pregnancy:
 

 Vivax: chloroquine

Falciparum:

1st trimester:. Quinine

2nd & 3rd trimester:  ACT

Treatment failure: give alternative ACT or Quinine + Doxycycline

  • Early treatment failure (ETF): 
    • severe malaria/ danger signs on Day 1, 2 or 3, + parasitaemia;
    • parasitaemia Day 2 higher > Day 0, irrespective of axillary temperature;
    • parasitaemia Day 3 with axillary temperature>37.5°C; and 
    • parasitaemia on Day 3, >25% of count on Day 0.
  • Late clinical failure (LCF): 
    • severe malaria/ danger signs btw D4 - D28 + parasitaemia
    • axillary temperature >37.5°C btw D4 - D28 + parasitaemia
  • Late parasitological failure (LPF): 
    • parasitaemia any day btw D7 -  D28 even with axillary temperature <37.5°C


 Complicated Malaria - Parenteral is must

 

Artesunate: 2.4mg/kg/dose diluted in 5% Sodium bi-carbonate

  • at 0 hr, 12th hr, 24th hour, 
  • then OD* 7days  (oral 50mg, 100mg tablets available can be started after 1 day of injectables)

+

Primaquine ( malirid 2.5mg, 5mg, 7.5mg, 15mg, 45mg)- not malarid

0.75mg/kg stat * 2nd  Day

Or


Quinine: diluted in D5%

  • Loading 20 mg/kg infused over 4 hrs (no loading if previously given)
  • Maintenance 10 mg/kg 8 hrly over 2hrs
  • Then oral 10mg/kg 8hrly * 7days ( if not able to take orally after 48hrs of initiation, iv maintenance dose reduced to 7mg/kg )
+
Doxycycline (3mg/kg *7days) / Clindamycin (10mg/kg BD*7days )
Doxy contraindicated in pregnancy & child < 8yrs
Or

Artemether: 

3.2 mg/kg i.m. stat then 1.6 mg/kg/day OD * 5 days

+

Primaquine ( malirid 2.5mg, 5mg, 7.5mg, 15mg, 45mg)- not malarid

0.75mg/kg stat * 2nd  Day


Chemoprophylaxis 

Short term: < 6 weeks : Doxycycline 1.5mg/kg upto 100mg OD 2 days before & 4 weeks after travel

Long term > 6wks: Mefloquine 5mg/kg upto 250mg weekly 2 weeks before & 4 weeks after travel


Severe malaria/ referral:

Severe anemia, jaundice, renal failure, coma, convulsions, shock, hemoglobinuria, > 106F temp, >5% of RBC have parasites