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Friday, October 31, 2014

Malaria: The Growing Menace

The growing incidence of drug resistance has become a cause of worry for the medical practitioners. Very soon we would be left with hardly any choices to combat the infectious agents. 

The common causes for this emerging resistance are:

  • Misdiagnosis
  • Incorrect choice of therapy
  • Inappropriate doses
  • Incomplete therapy

As much as we blame patients for stopping the therapy before its completion,  so also we should be blaming ourselves for incorrectly prescribing the treatment.   

I have laid down the basic guidelines for the outpatient therapy of uncomplicated Vivax and Falciparum malaria.  

As adapted from the "National Vector Borne Disease Program" (NVBDCP)- 2013:

Please make note that Primaquine needs to begin from Day 1 of therapy. 

Drug schedule for treatment of P falciparum malaria:

Thus, the cornerstone of malaria treatment is Artesimin based combination therapy (ACT)
ACT could either be a combination of Artesunate + Sulfadoxine-Pyrimethamine
Artemether + Lumefantrine.

As discussed above, Primaquine is a very integral part of the therapy in both Falciparum as well as Vivax malaria.

In Falciparum, it is given on Day 2 as a single dose of 45mg, to eradicate the gametocytes and thus prevent the further transmission of the parasite.

In Vivax, it is given from Day 1, 15mg per day for 14 days, to eradicate the hepatocyte stage seen only in vivax malaria.

"Together we can, together we will".

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