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Drug schedule for treatment of malaria under NVBDCP
1. Chloroquine
| Chloroquine base |
Day 1 |
10mg/kg (600 mg adult) |
| Chloroquine base |
Day 2 |
10mg/kg (600 mg adult) |
| Chloroquine base |
Day 3 |
5mg/kg (300 mg adult) |
Dosage as per age groups
Age in Years |
Day 1 |
Day 2 |
Day 3 |
Tab. Chloroquine |
Tab. Chloroquine |
Tab. Chloroquine |
<1 |
½ |
½ |
¼ |
1-4 |
1 |
1 |
½ |
5-8 |
2 |
2 |
1 |
9-14 |
3 |
3 |
1½ |
15& above |
4 |
4 |
2 |
2. Primaquine ¼
PRIMAQUINE IS CONTRAINDICATED IN INFANTS AND PREGNANT WOMEN
Dosage as per age groups
(a) P.Falciparum
Age in Years |
Primaquine on Day 1 |
mg base |
No. of Tablets (2.5 mg base) |
No. of Tablets (7.5mg base) |
<1 |
Nil |
|
0 |
1-4 |
7.5 |
3 |
1 |
5-8 |
15 |
6 |
2 |
9-14 |
30 |
12 |
4 |
15& above |
45 |
18 |
6 |
(b)P.Vivax
Age in Years |
Primaquine (Daily dose for 14 days*) |
mg base |
No. of Tablets (2.5 mg base) |
No. of Tablets (7.5mg base) |
<1 |
Nil |
Nil |
Nil |
1-4 |
2.5 |
1 |
1/3 |
5-8 |
5.0 |
2 |
2/3 |
9-14 |
10.0 |
4 |
1 1/3 |
15& above |
15.0 |
6 |
2 |
* Primaquine for 14 days should be given under medical supervision only
3.Artesunate + Sulpha - Pyrimethamine (ACT) Combination
Age wise Dose Schedule forAS+SP
Age |
1st Day
(number of tabs)* |
2nd Day
(number of tab) |
3rd Day
(number of tab) |
<1 Year |
AS |
½ |
½ |
½ |
SP |
¼ |
NIL |
NIL |
1-4 Year |
AS |
1 |
1 |
1 |
SP |
1 |
NIL |
NIL |
5-8 Year |
AS |
2 |
2 |
2 |
SP |
1½ |
NIL |
NIL |
9-14 Year |
AS |
3 |
3 |
3 |
SP |
2 |
NIL |
NIL |
15& above |
AS |
4 |
4 |
4 |
SP |
3 |
NIL |
NIL |
Strength of each Artesunate tablet : Contain 50 mg & each Sulpha Pyrimethamine (SP) tablet contain 500 mg sulphadoxine/ Sulphalene and 25 mg pyrimethamine
* Artemisinin group of drugs is not recmmended in pregnacy
** Primaquine should not be given with ACT combination as artesunate reduces gametocyte carriage.
4. Severe and complicated malaria cases
(1) In severe and complicated malaria of p. falciparum (clinically/ microscopically confirmed ) parenteral artemisinin or quinine is the drug of choice , irrespective of chloroquine resistance status of the area.
(2) Quinine salt, 10 mg/kg bw 8 hourly in 5% dextrose saline is preferred. Patients should be switched over to oral quinine as early as possible and oral dose is 10 mg/kg bw eight hourly not exceeding 2 gm in a day in any case. Minimum total duration for quinine therapy should be for 7 days including both parental and oral doses.
(3) Injectable form of artemisinine derivatives may be used for the management of severe and compilcated malaria (For adults and non-pregnant only) in the dosage given below.
· Artesunate : 2.4 mg/kg bw IM/IV followed by 1.2 mg/kg bw after 12 hours then 1.2 mg/kg bw once daily for total duration of 5 days.
· Artemether : 1.6 mg/kg bw IM followed by 1.6 mg/kg bw daily for total of 6 injections or 1.6 mg/kg bw IM injection twice daily for 3 days, a total of 6 injections.
· Arteether : 150 mg daily IM for 3 days in adults only.
· Artemisinin : 10 mg/kg bw at 0 and 4 hours followed by 7 mg/kg bw at 24, 36,48 and 60 hours.
5. Chemoprophylaxix
· In choroquine sensitive areas- choroquine
· In chlroquine resistant areas - chloroquine + proguanil
· Chemoprophylaxix is to be started a week before arriving to malarious area for visitors and for pregnant women prophylaxis should be initiated from second trimester.
· Start with loading dose of 10 mg/kg bw and followed by a weekly dose of 5 mg/kg bw. This is to continue till 1 month after delivery in case of pregnancy and in travelers till one month after return from endemic area. The terminating dose should be radical treatment for P. vivax i.e. 25 mg/kg bw over 3 days along with 0.25 mg/kg bw of primaquine for 14 days under medical supervision .
· Chemoprophylaxis with chloroquine is not recommended beyond 3 years because of its cumulative toxicity.
· In chloroquine resistant areas chemoprophylaxis is recommended with chloroquine 5 mg/kg bw weekly supplemented with proguanil 200 mg daily.
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