4. Dihydroartemisinin + Piperaquine (DHA-PPQ)
-
Dosage (Adult): 3 tablets once daily for 3 days.
-
Advantages: Once daily dosing is convenient, long half-life, good tolerability.
AI Generated, for reference only.
B. Treatment for P. vivax Malaria
Treatment for P. vivax is in two phases:
Phase 1 – Blood Stage Treatment Blood stage parasites are cleared with ACT or Chloroquine (where sensitivity exists).
-
Chloroquine Dosage (Adult):
-
Day 1: 600mg base followed by 300mg after 6-8 hours.
-
Day 2: 300mg base.
-
Day 3: 300mg base.
-
Total dose: 25mg/kg over 3 days.
-
Phase 2 – Radical Cure (Liver Stage Treatment)
P. vivax and P. ovale form hypnozoites in the liver which cause relapse. Primaquine is necessary to eliminate them.
-
Primaquine Dosage (Adult): 15mg base daily for 14 days.
-
Important Considerations:
-
Primaquine can cause hemolysis, especially in patients with G6PD deficiency. Testing is recommended before starting.
-
Contraindicated in pregnant and lactating women.
-
Treatment of Severe/Complicated Malaria
Severe malaria is a medical emergency and immediate treatment is essential. These patients should be admitted to the ICU.
A. Parenteral Artesunate (First Choice)
Parenteral artesunate is the first-line treatment according to WHO and Indian guidelines.
-
Dosage (Adult & Child):
-
2.4mg/kg IV or IM at 0, 12, and 24 hours, then once daily until the patient can take oral medicines.
-
Minimum 3 doses are necessary even if the patient can take oral medicine early.
-
-
Preparation:
-
Reconstituted with 5% sodium bicarbonate, then diluted in 5% dextrose or normal saline.
-
-
Why Artesunate? Reduces mortality by up to 35% compared to Quinine.
B. Artesunate + Other Supportive Drugs
In severe malaria, complications must be managed:
-
Cerebral Malaria: Anticonvulsants (Diazepam) for seizures.
-
Severe Anemia: Blood transfusion (Packed RBCs) if Hb <5 g/dL.
-
Renal Failure: Dialysis if indicated. Careful fluid management.
-
Hypoglycemia: 50% Dextrose IV bolus followed by continuous infusion.
-
Metabolic Acidosis: Sodium bicarbonate (if pH <7.2).
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