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Malaria

Feb 13, 2020

Malaria is a febrile illness due to malarial parasite, spread through mosquito bite, characterized by fever with chills, sweating, headache, muscle pain, nausea, vomiting or sore throat.

Medications:

Non falciparum malaria-

  • Tab. Lariago DS (Chloroquine 500 mg) 1 tablet once a day for 3 days.
  • Tab. Malirid DS (Primaquine 15 mg) 1 tablet once a day for 14 days. Contraindicated in infants, pregnant women and G6PD deficient patients.
  • We recommend ECG analysis before and during treatment to assess for QT prolongation.

Falciparum malaria-

  • Tab. Malirid DS (Primaquine 15 mg) 1 tablet as a single dose on presentation.
  • Tab. Lumet 80 (Artemether 80 mg, Lumefantrine 480 mg) – 1 tablet each at – 0 hours, 8 hours, 24 hours, 36 hours, 48 hours and 60 hours from presentation.

Malaria in pregnancy-

  • Treat P. Vivax with tab. Lariago DS (Chloroquine 500 mg) 1 tablet once a day for 3 days.
  • For P. Falciparum malaria in first trimester – tab. Qulaquine  (Quinine 324 mg) 2 tablets thrice a day for 7 days.
  • For P.  Falciparum malaria in 2nd and 3rd trimester – tab. Lumet 80 (Artemether 80 mg, Lumefantrine 480 mg) – 1 tablet each at – 0 hours, 8 hours, 24 hours, 36 hours, 48 hours and 60 hours from presentation.

Mixed Malaria infection-

  • Treat mixed malaria infection with 6 doses of tab. Lumet 80 as above and tab. Malirid DS for 14 days.

Supportive treatment:

  • Tab. Dolo 650 (Paracetamol 650 mg) 1 tablet 3 -4 times a day.
  • Tab. Domstal (Domperidone 10 mg) 1 tablet up to 3 times per day for nausea and vomiting.
  • Cap. Becozinc (Vitamin B, vitamin C and Zinc) 1 capsule once a day.

General advice:

  • Bed rest during acute illness.
  • Ensure adequate hydration.
  • Advice nutritious diet.
  • Regular follow up till clinical condition improves.
  • Ensure cleanliness of surrounding area to reduce mosquito breeding.

Investigations:

  • Malaria antigen card test – can be positive in falciparum or vivax.
  • Peripheral blood smear – to detect malarial parasite (gold standard).
  • Complete blood count – to rule out anaemia and infection.
  • Random blood glucose – can be low due to malaria or quinine.
  • Urine routine – to rule out haematuria as part of renal complication of malaria.

Referral:

Consider referral to secondary care if patient fails to respond or presents with additional complications.