6 Treatmentmalaria Final
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Transcript of 6 Treatmentmalaria Final
Control of malaria
MANAGEMENT OF MALARIA CASES:
• FIRST PRIORITY -CLINICAL MANAGEMENT FOR MORBIDITY, MORTALITY REDUCTION
ROLE OF PHCs:
HEALTH GUIDES,MULTI PURPOSE WORKERS TRAINED TO DETECT CASES
DRUG DISTRIBUTION CENTRES,FEVER TREATMENT DEPOTS
TREATMENT OF MALARIA
MANAGEMENT:MANAGEMENT:
LARGE HOSPITAL:LARGE HOSPITAL:
ideally should have the following facilities:
Round-the-clock coverage by qualified doctors and nurses
Facilities for intravenous infusion and central venous monitoring
Microscopy and rapid diagnostic test
Routine blood, urine,stool, biochemical tests
Blood transfusion
Oxygen therapy and ventilatory support
Facilities for doing a lumbar puncture
Facilities for specialized biochemical, radiological,microbiological tests
Facilities for intensive care management of critically illpatients
Facility for peritoneal/haemodialysis
SMALL HOSPITALS:SMALL HOSPITALS:Small hospitals/health facilities
are likely to have fewer than 50 beds.
Laboratory facilities are minimalOxygen is generally not availableblood transfusion facility may not
be available.Referral of patients with severe
malaria is advised.
BEFORE REFERAL:BEFORE REFERAL:PRE-REFERAL TREATMENTPREPARE REFERAL CARDADVICE TO ATTENDANTWHEN TRANSFERING:1.MAINTAIN A,B,C2.INSERT URINARY CATHETER IF
NEEDED3.START ANTI-MALARIAL THERAPY
REFERAL NOT POSSIBLE:REFERAL NOT POSSIBLE:FIRST AIDI.V FLUIDSSPECIFIC ANTI-MALARIAL
TREATMENTSUPPORTIVE MANAGEMENT
DISEASE CONTROL DISEASE CONTROL STRATEGIESSTRATEGIESCASE DETECTIONTREATMENTMASS DRUG ADMINISTRATION
CHEMOPROPHYLAXIS
CASE DETECTION:CASE DETECTION: ADULTS: NATIONAL DRUG POLICY ON MALARIA,2008
ALL FEVER CASES INVESTIGATED FOR MALARIA USING MICROSCOPY & RAPID DIAGNOSTIC USING MICROSCOPY & RAPID DIAGNOSTIC
KIT.KIT. FIRST LINE:CHLOROQUINE RESISTANT:ACT
(ARTESUNATE+SULPHADOXINE+PYRIMETHAMINE)
CHILDREN: CLASSIFY BASED ON
SIGNS&SYMPTOMS ,RISK CATEGORY OF THE AREA…..
ADULTS:ADULTS:CLINICAL MALARIA: IF RAPID DIAGNOSTIC KIT USED
FOR P.FALCIPARUM ONLY,NEGATIVE CASES SHOWING SIGNS AND SYMPTOMS OF MALARIA WITHOUT ANY OBVIOUS CAUSE-CLINICAL MALARIA
DIAGNOSIS WITH MICROSCOPY,RDK NOT POSSIBLE,CASE WITH SIGNS & SYMPTOMS OF MALARIA – CLINICAL MALARIA
CHILDREN:CHILDREN:VERY SEVERE FEBRILE VERY SEVERE FEBRILE DISEASE:DISEASE: FEVER + ANY GENERAL DANGER
SIGNS OR STIFF NECK -CLASSIFY AS VERY SEVERE
FEBRILE DISEASE -URGENT REFERAL + PRE
REFERAL TREATMENT WITH ANTIBIOTICS
NOTE: IN AREAS WHERE P.FALCIPARUM PRESENT- PRE REFERAL DOSE OF I.M. QUININE GIVEN
HIGH RISK AREA:HIGH RISK AREA: FEVER + NO GENERAL DANGER
SIGNS OR STIFF NECK-MALARIA TREATMENT JUSTIFICATION: HIGH RATE OF MALARIA
RISK IN AREA POSSIBILITY OF ANOTHER
ILLNESS CAUSING MALARIA TO PROGRESS
LOW MALARIA RISK AREA:LOW MALARIA RISK AREA:
FEVER + NO GENERAL DANGER SIGNS + NO MEASLES +NO OTHER CAUSE OF FEVER - MALARIA
RUNNY NOSE PRESENT OR MEASLES
PRESENT - FEVER MALARIA UNLIKELY
TREATMENT:TREATMENT:NATIONAL
MALARIA CONTROL PROGRAMME(1953-58)
-ANTI MALARIALS HAD LITTLE ROLE
NATIONAL MALARIA ERADICATING PROGRAMME(1958-TILL DATE)
-THEY HAVE AN IMMENSE ROLE
UNCOMPLICATED MALARIA-UNCOMPLICATED MALARIA-CHLOROQUINE:CHLOROQUINE:ALL SUSPECTED,CLINICAL MALARIA CASES:
PRIMAQUINE:PRIMAQUINE:
CHLOROQUINE:CHLOROQUINE: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
EACH TAB CONTAINS 150MG(BASE)
PRIMAQUINE-PRIMAQUINE-P.FALCIPARUMP.FALCIPARUMAGE(YRS) MG BASE NO OF TABLETS
<1 - -
1-4 7.5 1
5-8 15 2
9-14 30 4
>15 45 6
GIVEN AS SINGLE DOSE ON DAY ONE
PRIMAQUINE-PRIMAQUINE-P.VIVAXP.VIVAXAGE(YRS) MG BASE NO OF TABLETS
<1 - -
1-4 2-5 1
5-8 5 2
9-14 10 4
>15 15 6
GIVEN FOR 14 DAYS
ACT:ARTESUNATE+ ACT:ARTESUNATE+ SUFADOXINE/PYRIMETHAMINSUFADOXINE/PYRIMETHAMINEEAGE(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+-
EACH TAB OF:ARTESUNATE CONTAINS 50MG ARTESUNATES/P CONTAINS 500MG SULFADOXINE+ 25MG PYRIMETHAMINENOT RECOMMENDED IN PREGNANCYOTHER COMBINATIONS:ATRESUNATE+MEFLOQUINE ARTEMETHER+LUMEFANTRINE
NO RDK,MICROSCOPY AVAILABLE: NO RDK,MICROSCOPY AVAILABLE: LOW RISK AREALOW RISK AREA
NO RDK,MICROSCOPY NO RDK,MICROSCOPY AVAILABLE:HIGH RISK AREA:AVAILABLE:HIGH RISK AREA:
SEVERE COMPLICATED SEVERE COMPLICATED CASES:CASES: I.V.QUININE – 10MG/KG B.WT IN 5%
DEXTROSE SALINE OVER 4 HOURS, 8 HOURLY SWITCH TO ORAL DOSE AS SOON AS
POSSIBLE TOTAL DURATION OF TREATMENT = 7 DAYS INJ.ARTESUNATE CAN BE USED IN
ADULTS,NON PREGNANT WOMEN 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
NOTE:NOTE:SULFADOXINE/PYRIMETHAMINE
NOT USEFUL IN VIVAX MALARIAPRIMAQUINE CONTRA INDICATED IN
PREGNANT WOMEN,INFANTS,G-6-P-D DEFICIENCY
ACT NOT USEFUL IN VIVAX MALARIA.
ACT SHOULD BE GIVEN ONLY TO CONFIRMED P.FALCIPARUM MALARIA CASES.
TOXIC HAZARDS OF TOXIC HAZARDS OF DRUGS:DRUGS:CHLOROQUINE: NAUSEA,VOMITTING,HEADACHE,BLURRING
VISION,RETINAL DAMAGE(LONG TERM USE)PRIMAQUINE: GI EFFECTS,CNS,HEMOLYSIS(CVS) IN G-6-
PD DEFICIENT PEOPLE-stop primaquine immediately if he develops
symptoms like darkcoloured urine, yellow conjunctiva, bluish
discolouration of lips,abdominal pain, nausea, vomiting etc. and
should report to thedoctor immediately
DISEASE CONTROL DISEASE CONTROL STRATEGIESSTRATEGIESCASE DETECTIONTREATMENTMASS DRUG ADMINISTRATION
CHEMOPROPHYLAXIS
MASS DRUG MASS DRUG ADMINISTRATIONADMINISTRATION WHO REVISED STRATEGY: IT IS RECOMMENDED IN HIGHLY ENDEMIC
AREAS FOR CURBING TRANSMISSION+EXTENSIVE ANTIMOSQUITO MEASURES
MASS DRUG ADMINISTRATION IN CHILDREN <5YRS NOT RECOMMENDED :
1. MAY INTEFERE WITH DEVELOPMENT OF PROTECTIVE IMMUNITY
2.ACCLERATE DRUG RESISTANCE3.SCARCE RESOURSES MAY BE BETTER
USED FOR TREATMENT4.RISK OF RETINOPATHY
CHEMOPROPHYLAXISCHEMOPROPHYLAXIS RECOMMENDED FOR 1.TRAVELLERS FROM NON ENDEMIC
AREAS2.SHORT TERM FOR SOLDIERS,POLICE
FORCE,LABOUR FORCES DURING WORK IN ENDEMIC AREAS
3.PREGNANT WOMEN IN AREAS OF HIGH TRANSMISSION(BUT PROMPT TREATMENT OF CLINICAL EPISODES RECOMMENDED)
COMPLEMENT WITH PERSONAL PROTECTION
SHOULD BEGIN 1 WEEK BEFORE ARRIVAL IN MALARIOUS AREA,CONTINUED 4 WEEKS AFTER LEAVING THE AREA.
SIDE EFECTS OF CHLOROQUINE WITH LONG USE-
1.300MG WEEKLY FOR 5 YRS SCREEN TWICE YRLY FOR RETINAL CHANGES
2.100MG DAILY DOSE – START SCREENING AFTER 3 YRS
CHEMOPROPHYLAXIS:CHEMOPROPHYLAXIS:DRUG THERAPEUTIC
DOSEPROPHYLAXIS
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