Drug of choice for falciparum malaria in endemic area-
Ans. is 'a' i.e., Artemisinin Diagnosis 8c Treatment of malaria* All fever cases should be investigated for malaria either by microscopy or by Rapid diagnostic Test (RDT) for both vivax & falciparum, i.e., combo RDT (bivalent RDT).* Further treatment is as follows: -1) For plasmodium vivax3 days chlorquine plus 14 days Primaquine.2) For plasmodium falciparum: - Treatment for falciparum malaria is Artemisinin combination therapy (ACT). It includesi) ACT-AL for North-Eastern states: Artemether with lumefantrine for 3 days plus single dose primaquine on 2nd day.ii) ACT-SP for all other states: Artesunate for 3 days plus sulfadoxine-pyrimethamine on day 1 plus single dose primaquine on day 2.3) Treatment of mixed infection: - Should be treated as falciparum malaria. But primaquine is given for total 14 days (not a single dose on day 2 as is given for falciparum infection).4) When microscopy results are not available within 24 hours or if RDT for only falciparum (monovalent RDT) is used: -A) Patient at high risk area for Pf (TfR >1% and Pf% >30% in, last 3 year)a) P. falciparum RDT positive - Treat as falciparum malaria (as above).b) P. falciparum RDT negative - Send blood slide to laboratory, and give chloroquine for 3 days, and await microscopy results: -i) +ve for vivax - Primaquine for 14 days.ii) +ve for falciparum - Treatment of falciparum malaria as above.B) Patient not at high-risk area for Pf# Weight for slide results, give chloroquine for 3 days and treat definitely according to species of slide results.5) When Microscopy results are not available with in 24 hours and bivalent RDT (for both vivax and falciparum) is usedi) Positive for P. vivax: Treat for vivax infection (see above).ii) Positive for P. falciparum: Treat for falciparum infection (see above).iii) Positive for mixed infection: Treat for mixed infection (see above).6) Treatment of severe malaria: - Severe manifestations (e.g., Unconsciousness, Convulsions, Coma, Metabolic acidosis etc) can develop in P. falciparum infection. Treatment is as follows: -i) Start with parentral artimisinin derivative (artesunate, artemether, arteether) or quinine.ii) Once patient can take oral therapy: -a) Patients receiving parentral quinine should be treated with oral quinine along with doxycyclin for 7 days. In pregnant women clindamycin is given instead of doxycyclin.b) Patients receiving artemisinin derivatives should get full course of oral ACT.
Artemisinin
Chloroquine
Mefloquine
Halofantrine
Communicable Diseases