Treatment of uncomplicated malaria

2021-03-23 12:00 AM

There are clinical manifestations of malaria, but the parasite has not been found in the blood, and after eliminating fever from other causes.

Treatment target and object

Target

Treatment of malaria is a way to use drugs to kill malaria parasites in the patient's body to restore the health of the patient and also to cut the transmission in the community.

Subjects of treatment

People needing treatment for malaria include:

Patients with typical clinical manifestations of malaria and malaria parasites found in the blood.

There are clinical manifestations of malaria but the parasite has not been found in the blood and after eliminating fever from other causes.

The person carrying the cold parasite (found the malaria parasite in the blood but did not have a fever)

Malaria medicine

Medicines of plant origin

Quinine: The Alcaloides extracted from the quinquina tree in 1890. The drug is produced in the form of sulfate, chlohydrate, forminate ...

Effects: Kill asexual in erythrocytes, young gametocytes of P. vivax and P.ovale (not kill the gametocytes of P. falciparum and dormant in the liver)

Dosage form: Quinine sulfate tablet 300mg or quinine chlohydrate 250mg and 500mg; Intramuscular injection form of deep muscle or intravenous infusion of quini đichlohydrrate 500mg.

Artemisinin and its derivatives Quinghaosu (Artemisia annua L): Artemisinin has been extracted and put into use since 1973. Currently, there are many drugs that are derivatives of artemisinin such as Artesunate, artemether, dihydroartemisinin.

Effects: Rapidly eradicate the asexual form of the parasite in erythrocytes. Recently, the drug has an inhibitory effect on the formation of gametes. In addition, artemisinin also works to prevent the adhesion of parasitic infected erythrocytes into the endothelium, one of the mechanisms of malignant malaria.

Dosage form: Artemisinin 250mg, artesunat 50mg, artemisinin 100mg, 200mg, 300mg, artesunat 50mg, 100mg bullet; Tube form: Artesunat 60mg can be injected intramuscularly or intravenously, artemether tube 100mg intramuscularly.

Synthetic drugs

Nhóm 4 – aminoquinolein: Chloroquin (1945), amodiaquin…

Effect: Kills clones in erythrocytes.

Dosage form: Tablets: Chloroquin 100mg, 300mg; Tube form: Chloroquin 100mg (2ml).

Nhóm Aryl – amino – alcohols: Mefloquin (1972), halofantrin (1998).

Effect: Kills clones in erythrocytes.

Dosage form: 250mg tablet

Nhóm Antifolic, Antifolinic: Sulfamides, sulfon, pyrimethamine (1951), proguanil (1948).

Effect: Kill the clones in slow red blood cells.

Dosage form: Primaquin diphosphate 7.5mg base (13.5mg)

Antibiotic group: Cyclines (tetracycline, doxycyclin), Macrolides, Fluoroquinolones.

Effects: Kills clones in weak red blood cells, often in combination with other malaria drugs.

Chloroquin: 250mg tablet (contains 150mg base).

Dose: Total dose of 250mg base/kg body-weight, divided into 3 days of treatment.

Day 1: 10mg base / kg body weight.

Day 2: 10mg base / kg body weight.

Day 3: 5mg base / kg body weight. 

Artesunat: 50mg tablet.

Dosage: Total dose of 16 mg/kg body weight divided into 7 days of treatment.

Day 1: 4mg / kg body weight.

From 2-7 days: 2mg / kg body weight.

DHA – P (Dihydroartemisinin – piperaquine):

As a combination drug, each tablet contains 40mg dihydroartemisinin + 320mg piperaquine phosphate.

Tablets CV-8:

As a combination drug, each tablet contains: Dihydroartemisinin 32mg + piperaquin phosphate 90mg + trimethoprim 90mg + primaquin phosphate 5mg.

Artesunat rectal tablets: type 50mg, 100mg.

Dosage: On the first day, place 2 times, from 2-7 days a day according to the dose:

Year old

Dose for one set

Note

Under 1 year old

50mg

Do not ding for patients with diarrhoea (diarrhoea).

When the patient is awake, can drink, switch to oral medicine for the full 7 days

1 - under 5 years old

100mg

5 - under 15 years old

200mg

Be at least 15 years old

300mg

Treatment of common malaria (uncomplicated)

Choose malaria drugs

Group

patient

Clinical malaria

Malaria caused by P. falciparum

Malaria caused by P. vivax

Combined malaria infection

Under 3 years old

Dihydroartemisinin – piperaquine* hoặc artesunate

Dihydroartemisinin – piperaquine hoặc artesunate

Chloroquine

Dihydroartemisinin – piperaquine hoặc artesunate

From 3 years old and up

 

 

 

Artesunat or

chloroquin or

Dihydroartemisinin – piperaquin

 

Dihydroartemisinin – piperaquin**

or artesunat +

primaquin **

or CV-8

 

Chloroquin + primaquin

 

 

 

 

Dihydroartemisinin – piperaquin**

or artesunat + primaquin **

or CV-8

 

 

Pregnant women under 3 months

Quinin or

Quinine +

clindamycin

Quinin or

Quinine +

 clindamycin

Chloroquine

Quinin

or Quinine +

clindamycin

Pregnant women 3 months and older

Dihydroartemisinin – piperaquine

or artesunate **

Dihydroartemisinin – piperaquine

or artesunate **

Chloroquine

Dihydroartemisinin – piperaquine

or artesunate **

Note:

Dihydroartemisinin - piperaquine (with the brand name CV Artecan, Arterakine ...).

Test the blood of the patient with gametes.

Treatment of artesulfate without dihydroartemisinin-piperaquine.

Track clinical results

Must be closely monitored by taking the temperature every 3 hours while the patient has a fever. If after 3 days of treatment, but the patient still has a fever or worsening condition and there is a parasite in the blood, the drug must be replaced. If there are no more parasites, another cause must be found.

Track the results of the parasite

Take a test of parasitic strain and density of parasites on the day of initiation of treatment, 2 days and 7 days after treatment to evaluate the effectiveness of the drug.

Classification of treatment response

Failure of early treatment: By day 3 of treatment, clinical symptoms do not decrease or worsen and malaria parasites remain in the blood.

Treatment failure is long: From day 4 to day 28, patients with fever and malaria parasites return.

Cure: No fever and malaria parasites clear after 3 days of treatment until 28th day.

Criteria for discharge

Free of fever and parasites (preferably ≥ 7 days), normal eating and sleeping.

Red blood cells ≥ 3.5 million / ml, white blood cells are normal.

Normal liver and kidney function.