Antimalarial drugs - (Adults) Cnloroquine-sensitive, uncomplicated P. falciparum malaria. P. malariae. and P. ovale malaria

Antimalarial drugs - (Adults) Cnloroquine-sensitive, uncomplicated P. falciparum malaria. P. malariae. and P. ovale malaria 1. Chloroquine saulphate • Sensitive but severe malaria - Parenteral administration, total dose of 25mg/kg given as either 3.5 mg/kg s.c or i.m 6/hrty, or 0.83 mg/kg./ hr. uncomplicated chloroquine-resistant P falciparurn and P. vivax malaria -2 Quinine sulphate10 mg/kg. 8 hourly p.o. for 7 days, or Quinine 7 mg/kg (Max 400 mg) IV at constant rate over 30 min. followed by 10 mg/kg overnext 4 hrs., then 10 mg 8 hourly for 7 days. Infusion time 3-4 hours. Side-effects of quinine -Hypotension. hypoglycemia, cardiacarrhythmias. 3. Sulphadoxine/pyrimethamine Sulphadoxine 25 mg/kg plus Pyrimethamine 1.25 mg/kg, as single oral dose. ifresistance to sulphadoxine/pyrimethamine known or suspected - Doxycycline 200 mg once, then 100 mgdaily for 6 days orTetracycline 5 mg/kg (max. 250 mg) q.d.s for 7 days (should not be given to children or pregnant women). 4. Meltoquine - 2doses of 15 mg/kg 12 hourly p.o. (Maximum dose 1000 mg.) Contraindicated in those on -blocking drugs, and it history ofneuropsychiatric disease including epilepsy. Side-effects - Nausea, vertigo, confusion, psychosis and convulsions. 5. Artemisinin(a) Artemether 200 mg p. o. Initial dose,followed by 100 mg 6 hours later, then 100 mg daily for 4 days (total dose 700 mg). It clears parasites rapidly with virtually no sideeffects, but high rate of recrudescence. (b) Artesunate. Oral-100 mg b.d on 1st day,then 50 mg b.d. for 4-6 days. Children half the adults dose. Parenteral: 120 mg i.v. or i.rn on day 1 followed by 60 mg o.d. for next 4days. Total dose 360-480 mg. 6. Halofantrine - (9 phenanthrene methanal) Dosage: Adults p.o. 600 mg q6h for 3 doses.ChildrenB mg/kg q6h. Adverse effects - Prolongation of PR and QT intervals. Nausea, vomiting, abdominal pain, darrhoea. Orthostatichypotension, pruritus and rash. Raraly intravascular hemolysis. Radical cure of P. vivax or P ovale Primaquine -15 mg/day p.o.for 14 days. Side-effects - Cyanosis (due to methemoglobin), colicky abdominal pains. Acute hemolysis may occur in G6PDdeficient individuals. (P. malariae does not have a hypnozoite stage, hence primaquine treatment is not required) Clinicalmanifestations of fulminant PI. falciparum malaria 1. Cerebral Pyrexia (often >105°F) Confusion Drowsiness progressing tocoma Seizures Ocutogyric crisis. Retinal hemorrhages. Extensor plantars 2. Acute renal faiture caused by acute tubular necrosis3. Hypotension and shock 4. Hypoglycemia 5. Pulmonary: ARDS Acute pulmonary oedema 6. Severe anemia 7.Hypertactacidaemia caused by umpaired tissue perfusion in tissues occupied by sequestered parasites, and exacerbated