Training Module for Medical Officer - NVBDCP

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Chloroquine, quinine, sulfadoxine-pyrimethamine, artemisinin derivatives:artesunate, arte-mether and arte-ether.2) Gametocytocidal and anti-relapse drugPrimaquine.3.4.2 Selection of drugsAll fever cases diagnosed positive by either RDT or microscopy need to be promptlystarted on effective treatment. The treatment will depend upon the species ofPlasmodium diagnosed.Treatment of uncomplicated falciparum malariaArtesunate 4mg/kg daily for 3 days plus sulfadoxine-pyrimathamine 25mg/kg + 1.25mg/kg as a single dose on the first day (ACT) plus primaquine (PQ) in a single dose onthe first day.In low-risk areas with PV predominance and Pf is sensitive to chloroquine resistance, thePf cases will be treated with chloroquine and primaquine. Similarly, the clinical cases(unconfirmed cases) will also be treated with chloroquine in situations where diagnosis isnot possible within reasonable time, no later than the day after fever is reported to thehealth facility.Contra-indicationsPrimaquine is contraindicated in pregnancy, children under one year and persons with ahistory of haemolysis following primaquine treatment. Patients belonging to thesecategories should not receive primaquine.PrecautionsSulfadoxine-pyrimethamine can, in rare,cases cause serious cutaneous or mucocutaneouseruptions and/or agranulocytosis. Any patents with a cutaneous or mucocutaneousreaction within a month after taking sulfadoxine-pyrimethamine should, ifthere is not an obvious alternative explanation be considered allergic to sulphonamidesand not be given sulfonamide treatment again.Suspected cases of ACT side effects should be reported to NVBDCP with individualcase reports.Artemisnin derivative monotherapy must not be given under any circumstance foruncomplicated malaria, as there is great concern that use of such monotherapy couldlead to artemisinin resistance.Treatment failuresTreatment failures are expected to be very rare with ACT. Most cases of apparenttreatment failures will probably be caused by inadequate patient compliance. Therefore,apparent treatment failures should be re-treated with ACT, if they occur at least 14 daysafter initial treatment. Earlier treatment failures should be treated with quinine tominimize the risk of side-effects from repeated treatment with sulfadoxinepyrimethamine.20
NVBDCP and NIMR jointly monitor the suscebility to ACT in sentinel sites.Treatment of uncomplicated vivax malariaChloroquine (CQ) for 3 days (Day 1: 10mg/kg + Day 2: 10mg/kg + Day 3: 5mg/kg) plusprimaquine 0.25mg/kg daily for 14 days as per prescribed guidelinesPrimaquine contra-indications: See above.ExplanationP.vivax in India remains fully sensitive to chloroquine. This is monitored by NIMR. Inrecent years, controlled trials have failed to demonstrate any anti-hypnozoite (antirelapse)effect of primaquine, when given for 5 days. NVBDCP has therefore adoptedthe 14 day regimen recommended by WHO.Treatment of uncomplicated mixed infections (of PF and PV)Artesunate for 3 days plus sulfadoxine-pyrimathamine in a single dose on the first dayplus primaquine for 14 daysContra-indications: See above.An algorithm for the diagnosis and treatment of fever cases for malaria is given in Figure3.1.21
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Training Module for Medical Officer - NVBDCP

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