Management of uncomplicated malaria

 UNCOMPLICATED MALARIA

Diagnosis and Treatment of Uncomplicated Malaria

By the end of this article one should be able to describe :

  • Diagnosis of uncomplicated malaria
  • Recommended medicines and dosages for uncomplicated malaria
  • Appropriate use of antimalarial medicines and counseling adequately
  • Follow up care

Summary

  • The policy direction in management uncomplicated malaria
  • Proper diagnosis – test methods available
  • Effective malaria treatment for all who test positive
  • Manage treatment failure and other complications
  • Follow up care for all

Diagnosis of Uncomplicated Malaria Definition:  

This is a condition which presents with fever in the presence of peripheral parasitaemia It is caused by parasites of the genus of plasmodium. Plasmodium falcipurum causes 98.2% of the infections while plasmodium malariae and plasmodium ovale causes 1.8% . Plasmodium vivax has not been identified (KMIS 2015) Symptoms generally occur 7-10 days after the initial mosquito bite. Symptoms are non-specific and can include fever, moderate to severe shaking chills, profuse sweating, headache, nausea, vomiting, diarrhoea and anaemia, with no clinical or laboratory findings of severe organ dysfunction

Common Signs and Symptoms of Uncomplicated Malaria

  • Fever
  • Chills
  • Profuse sweating
  • Muscle pains
  • Joint pains
  • Abdominal pain
  • Diarhoea
  • Nausea
  • Vomiting
  • Irritability
  • Refusal to feed
  • (Sometimes the symptoms may be non-specific)

Malaria diagnosis

  • In ALL age groups:
  • All suspected malaria cases should be tested for malaria
  • If the test is positive: Treat for malaria
  • If the test is negative: DO NOT treat for malaria, reassess the patient and treat appropriately
  • Record results in provided tools

Recommended medicines and Dosages

  • What is the recommended treatment for the management of Uncomplicated Malaria?
  • First line Treatment
  • Second line Treatment 

Recommended Drugs and Dosages

  • First Line Treatment: Artemether + Lumefantrine (AL)* 6 doses given over 3 days
  • Dispersible AL is available and recommended for children
  • Below 5Kg: to be given one tablet of AL under supervision

Second Line Treatment

Piperaquine (DHAP+PPQ) three doses given over 3 days

Supportive Treatment

Fever Management

  • The recommended methods are: Medicine, such as Paracetemol, ibuprofen
  • Mechanical methods: Tepid* sponging, exposure, fanning, etc.

Fluids and Nutrition

  • Encourage giving extra fluids; continue breastfeeding where applicable

*Tepid – means lukewarm

 

Dosing Schedule for AL Weight Age in years Dose of AL to be administered at 0 hrs, 8hrs, 24hrs, 36hrs, 48 hrs and 60 hrs
0 < 15 kg O < 3years 20 mg Artemether and 120 mg Lumefantrine
15<25kg 3< 8 years 40 mg Artemether and 240 mg Lumefantrine
25<35 kg 8 < 11 years 60 mg Artemether and 360 mg Lumefantrine
Above≥ 35 kg 12≥ years and above 80 mg Artemether and 480 mg Lumefantrine

 

 

Dispensing and counseling practices

Dispensing and Counseling

  • Weigh the patient
  • Select appropriate dosage
  • Inform the patient why they are being given the drug
  • Explain dosing schedule Emphasize need to complete all doses—even if the patient is feeling better
  • Give first dose under observation(DOT)
  • Observe patient for 30 minutes for vomiting
  • If patient vomits, repeat the dose
  • Advise to return IMMEDIATELY if condition worsens
  • Advise to return after 3 days if fever persists
  • Check that the patient or caregiver has understood the instructions before leaving the clinic

Note:

  • Give 1st dose as a DOT
  • 2nd dose should be given at 8 hours after the 1st dose
  • 3rd dose 24hrs after the first
  • 4dose 36hrs after the first dose
  • 5th dose 48hrs after the first dose
  • 6th dose, 60hrs after the first dose

Suspected treatment failure and follow-up care

Suspected Treatment Failure

  • It is failure to achieve desired therapeutic response after initiation of therapy
  • May result from non-adherence, vomiting, wrong diagnosis, unusual drug pharmacokinetics, drug resistance, poor quality medicines
  • Should be suspected if there is no improvement 3-14 days after initiation of treatment
  • If symptoms reappear after 14 days treat as a new infection

 

Management of suspected treatment failure

  • In cases of non-adherence or non-completion repeat full course of AL after addressing the cause (of non adherence).
  • Malaria microscopy should be used to confirm (RDTs not recommended)
  • In facilities with no microscopy patients with suspected treatment failure should be referred
  • Treat confirmed cases with Dihydroartemisinin-Piperaquine
 Dihydroartemisinin + Piperaquine dosing schedule Body Weight Dose of Dihydroartemisinin Piperaquine to be taken once daily for 3 days
5 to < 8kg 20 Dihydroartemisinin + 160 Piperaquine
8 to 11 kg 20 Dihydroartemisinin + 160 Piperaquine
11 to < 17kg 30 Dihydroartemisinin+ 240 Piperaquine
17 to < 25kg 40 Dihydroartemisinin+ 320 Piperaquine
25 to < 36 kg 60 Dihydroartemisinin+ 480 Piperaquine
36 to < 60 kg 80 Dihydroartemisinin + 640 Piperaquine
60 to < 80 kg 120 Dihydroartemisinin +960 Piperaquine
 

80 kg

 

200 Dihydroartemisinin+ 1600 Piperaquine

 

 

 

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