National Drug Policy on Malaria

1. All fever cases preferably be investigated for malaria by  microscopy or Rapid Diagnostic kits (R.D.K.).

2. The first line of treatment is chloroquine and second line is A.C.T. ( Artesunate+Sulpha Pyrimethamine) combination. In case resistant to these formulations and to treat severe and complicated malaria quinine will be the drug of choice.

3.   Microscopically positive PF cases should be treated with chloroquine in therapeutic dose of 25mg per Kg. body weight over three days and single dose of Primaquine 0.75mg per Kg. bw on the first day. This practice is to be followed at all levels including VHWs like DDCs/FTDs/ASHA as well.

4.   Microscopically positive PV cases should be treated with Chloroquine in full therapeutic dose of 25 mg/Kg. body weight over three days. This practice is to be followed at all levels including VHWs like DDCs/FTDs/ASHA etc. Primiquine can be given in dose of 0.25 mg per Kg. body weight for 14 days under medical supervision only to prevent relapse.

5.   Fever cases positive by RDK should be treated according to the diagnosed species as described above. However, if RDK for only PF is used, negative cases showing sign and symptoms of malaria without any other obvious causes  should be considered as, "Clinical malaria" and treated with Chloroquine in full therapeutic dose of 25 mg./ Kg. body weight over three days.

6.   In situation where diagnosis by microscopic or RDK is not possible cases showing sign and symptoms of Malaria without any other obvious causes should be considered as clinical malaria and treated with Chloroquine in full therapeutic dose of 25 mg./Kg. body weight over 3 days in low risk area while in high risk area single dose of Primaquine 0.75 mg/Kg. body weight should also be given on the first day. This practice is to be followed at all levels including VHWs like DDCs/FTDs/ASHA as well.

7.   ACT is the first line of Anti-malarial drug for treatment of P. falciparum in chloroquine resistant areas. The dose is 4 mg/Kg body weight of artesunate daily for 3 days + 25 mg / Kg. body weight of sulphadoxine / sulphalene + 1.25 mg/kg body weight of pyrimethamine on the  first day. ACT should be given only to confirmed P. falciparum cases found positive by microscopy or Rapid Diagnostic kits. Compliance and full intake is to ensured. Primaquine should not be given with ACT combination as artesunate reduces gametocyte carriage.

8.   The area / PHC showing a treatment failure more than 10% ( both early and late treatment failures) to the tested drug chloroquine in the minimum sample of 30 cases, should be switched over to the alternate anti-malarial drug i.e. Artesunate - Sulpha-Pyrimethamine (ACT) combination.

9.   Change of drug to second line of treatment may also be implemented in a cluster of PHCs around the resistant foci after taking into consideration the epidemiological trend of P.falciparum (PF> 30%) and clinical response in this areas and approval of Directorate of N.V.B.D.C.P.

10.  Resistance should also be suspected if in spite of full treatment with no history of vomiting, diarrhea patient does not respond within 72 hours parasitologically. Such patients should be given alternative drug i.e. ACT combination and report to concern District Malaria / State Malaria Officer / R.O.H.F.W. PF monitoring teams for monitoring of drug sensitivity status.

11.  In areas with high disease burden in proportion of PF, inadequate facilities for laboratory diagnosis and inaccessibility and relatively poor communication facilities and the PF Chloroquine resistant pockets, ACT may also be given on clinical diagnosis of malaria by a trained Medical Officers or trained Para-Medical Personnel after excluding other common causes of fever.

12.  The cases resistant to CQ  and SP-ACT , oral quinine with tetracycline or doxycline can be prescribed.

13.  Mefloqine should only be given in chloroquine / multi-resistant uncomplicated P.falciparum cases only in standard doses as prescribed by  WHO. This drug is to be made available through the Depot system and only to be provided to patients against the prescription  of medical practitioners supported by laboratory report showing asexual stage of P. falciperum parasite and not gametocyte alone and other species.

14.  Primaquine is contra indicated in pregnant woman and infants.

15. Chemoprophylaxis is recommended in selective cases. It is recommended for,

In Chloroquine sensitive areas, weekly dose of Chloroquine will be given but in Chloroquine resistant areas it should be supplemented by daily dose of proguanil. However chemoprophylaxis should not exceed 3 years due to the cumulative toxic effect of chloroquine.

16. In sever and complicated P. falciperum malaria cases intra-venous Quinine/ parenteral Artemisinine derivatives ( for adults and non-pregnant woman only) are to be given irrespective of Chloroquine resistance status. In case of non-availability of above drugs. Chloroquine 10 mg/Kg. body weight in isotonic saline should be infused over 8 hours followed by 15 mg/Kg. body weight in the next 24 hours. This treatment may continue till such time Quinine/Artemisinine derivatives become available.

17. Migratory labour / project population : Since this groups belongs to high risk category they need to be screened on weekly basis and treated accordingly.

18. All the medical, para-medical and village level health volunteers should be adequately trained before their involvement in the Programme.

19. Artesunate tablets should be administered as mono-therapy. It should invariably be combined with sulpha-pyrimethamine tablets in prescribed dosages.