Malaria A Case Study & Standard Treatment

2. Affan Ali
Roll No. 36
CASE STUDY

3. Demographics
Name: Muhammad Ali
 Age: 21 Years
 Gender: Male
 Marital Status: Un Married
 Ward: Medicine
 Hospital: Dow University Hospital


4. History
No Disease History
 Not on Medication


5. Present Complains
Morning & Midnight High Grade Fever
for 5days
 Chills for 5days
 Vomiting for 1 day
 Epigastric Pain
 Sweating
 Weakness


6. Laboratory Findings
Haemoglobin • 11.3g/dl
RBCs
• 3.7 x108/µl
MCV
• 93 fl
MCH
• 31 pg
MCHC
• 33%
PCV
• 34%

7. Laboratory Findings
Total Leukocytes • 3.1 x103/µl
Neutrophils
• 29%
Eosinophils
• 1%
Basophils
• 0%
Monocytes
• 11%
Lymphocytes
• 59%
Platelets
• 95 x103/µl

8. Laboratory Findings
Sodium
• 140 mEq/l
Potassium
• 3.4 mEq/l
Chloride
• 105 mEq/l
Bicarbonate • 29 mEq/l
Urea
• 42.4mg/dl
Sr. Creatinine • 0.9 mg/dl

9. Laboratory Findings
Dengue
IgG
P.
Falciparum
P. Mix
Typhi Dot
Negative
Negative
Positive
Negative

10. Diagnosis

11. PRESCRIPTION

12. Ceftriaxone

13. Artemether/ Lumefantrine

14. Omeprazole

15. Metoclopramide

16. Acetaminophen

17. Vitamin B Complex

18. Others
Dextrose Saline @ 100cc/hour
 Normal Saline @ 100 cc/hour


19. JUSTIFICATIONS

20. Ceftriaxone
Prescribed for Prophylaxis of Hospital
Acquired Infections
 Dose is Accurate (1- 4gm daily A/C
severity)
 Frequency is appropriate (BD)
 Route is appropriate (IV)
 No Interaction with other Prescribed
Drugs


21. Artemether/Lumefantrine
Prescribed for Treatment of Malaria
 Dose is Accurate (80/480mg)
 Frequency is appropriate
 Route is appropriate (Oral)
 No Interaction with other Prescribed
Drugs


22. Omeprazole
Prescribed for Prophylaxis of Bed
ridden ulcer
 Dose is Accurate (40mg)
 Frequency is appropriate (OD)
 Route is appropriate (IV)
 No Interaction with other Prescribed
Drugs


23. Metoclopramide
Prescribed for Treating vomiting
 Dose is Accurate (10mg)
 Frequency is appropriate (q8h)
 Route is appropriate (IV)
 Increases Rate of Absorption of
Acetaminophen


24. Acetaminophen
Prescribed for Treating Fever, Pain etc
 Dose is Accurate (1gm)
 Frequency is appropriate (q4 – 6hrs)
 Route is appropriate (IV)
 Rate of Absorption is increased by
Metoclopramide


25. Vitamin B Complex
 Riboflavin (Vitamin B2):100mg
 Thiamine HCl (Vitamin B1):100mg,
 Cyanocobalamin:50mcg
Prescribed for treating anemia
 Dose is Accurate
 Frequency is appropriate
 Route is appropriate
 No Interaction with other Prescribed
Drugs


26. THE DISEASE

27. Malaria

Malaria, one of the most widespread
diseases, caused by Plasmodium
Species

Transmitted by infected individuals
via
◦
◦
◦
◦
Mosquito Bite
Blood transfusion,
Congenitally,
Infected needles by drug abusers

28. Types & Causative Agents

29. SYMPTOMS
29

30. Life Cycle of Plasmodium
Two interdependent life cycles

Sexual cycle: occurs in the mosquito

Asexual cycle: occurs in the human
◦ Exo erythrocytic Phase
◦ Erythrocytic Phase
30

31. Life Cycle of Plasmodium
31

32. TREATMENT

33. MALIGNANT MALARIA

34. Quinine

Adult Oral Dose
◦ 600mg q 8 hrs for 5 – 7 days with or followed
by





Doxycycline 200mg OD for 7days
Or
Clindamycin 450mg q 8 hrs for 7days
Or if parasite is likely to be resistant
Pyrimethamine 75mg / sulfadoxine 1.5g as a single
dose

35. Quinine

Pediatric Dose – Oral
◦ 10mg/kg (Max 600mg) q 8 hrs for 7 days with or
followed by




Clindamycin 7 – 13 mg/kg (Max 450mg) q 8 hrs for 7days
Or
Over 12 years Doxycycline 200mg OD for 7days
Or if parasite is likely to be resistant use pyrimethamine &
sulfadoxine combination
Age
Dose
< 4 years
Pyrimethamine 12.5mg / sulfadoxine 250mg
5–6
Pyrimethamine 25mg / sulfadoxine 500mg
7–9
Pyrimethamine 37.5mg / sulfadoxine 750mg
10 - 14
Pyrimethamine 50mg / sulfadoxine 1g

36. Quinine

Adult Parenteral Dose
◦ Loading Dose 20mg/kg (Max 1.4gm)
infused IV for 4 hours every 8 hours
◦ Maintenance Dose 10mg/kg (max 700mg)
infused IV for 4 hours every 8 hours

Pedriatric Dose – Parenteral
◦ Same as Adult adjusted according to
weight

37. Alternative Treatment
Atovaquone / Proguanil
 Artemether / Lumefantrine


38. Atovaquone / Proguanil

Adult Oral Dose
◦ 4 Standard Tablets Once Daily for 3 days
 A standard tablet contains 100 mg of proguanil
hydrochloride and 250 mg of atovaquone

39. Atovaquone / Proguanil

Pediatric Oral Dose
Body Weight
Dose
> 40 kg
Same as Adult Dose
5 – 8 kg
2 Pediatric Tablets OD for 3 days
9 – 10 kg
3 Pediatric Tablets OD for 3 days
11 – 20 kg
1 Standard Tablet OD for 3 days
21 – 30 kg
2 Standard Tablet OD for 3 days
31 – 40 kg
3 Standard Tablet OD for 3 days
A pediatric tablet contains 25 mg of proguanil
hydrochloride and 62.5 mg of atovaquone

40. Artemether / Lumefantrine

Adult Oral Dose
◦ 4 Standard Tablets initially followed by 5
more same doses at
 8, 24, 36, 48 & 60 hours
 A standard tablet contains 20 mg of Artemether
and 120 mg of Lumefantrine

41. Artemether / Lumefantrine

Pediatric Dose – Oral
Body Weight
Dose
> 35 kg (> 12yrs)
Same as Adult Dose
5 – 15 kg
1 Tablet followed by 5 more doses at 8, 24,
36, 48 & 60 hours
15 – 25 kg
2 Tablet followed by 5 more doses at 8, 24,
36, 48 & 60 hours
25 – 35 kg
3 Tablet followed by 5 more doses at 8, 24,
36, 48 & 60 hours
A standard tablet contains 20 mg of Artemether
and 120 mg of Lumefantrine

42. Pregnanacy
Falciparum Malaria is dangerous in
Pregnancy specially in last trimester
 Following are Safe

◦ Quinine
◦ Clindamycin

Following should be avoided
◦ Doxycycline
◦ Atovaquone / Proguanil
◦ Artemether / Lumefantrine

43. Chloroquine is drug of choice in Benign Malaria
BENIGN MALARIA

44. Chloroquine
The adult dosage regimen for
chloroquine by mouth is:
 initial dose of 620 mg then
 a single dose of 310 mg after 6 to 8
hours then
 a single dose of 310 mg daily for 2 days
 (approximate total cumulative dose of 25
mg/kg)


45. Primaquine
It is used for Radical Cure (Prevent
Relapse) in the case of P. vivax & P.
ovale
 P. malariae

◦ Not required

P. vivax
◦ 30 mg daily for 14 days following
chloroquine

P. ovale
◦ 15 mg daily for 14 days following

46. Chloroquine in Pediatrics
The dosage regimen is:
 initial dose of 10 mg/kg (max. 620 mg)
then
 a single dose of 5 mg/kg (max. 310
mg) after 6–8 hours then
 a single dose of 5 mg/kg (max. 310
mg) daily for 2 days


47. Primaquine in Pediatrics
Should not be given to children under
6 months without specialist advice
 P. vivax

◦ 500mcg / kg (Max 30 mg) daily for 14
days following chloroquine

P. ovale
◦ 250mcg / kg (Max 15 mg) daily for 14
days following chloroquine

48. Parenteral for Adult &
Pediatrics

IV infusion of Quinine
◦ 10mg / kg (Max 700mg) for 4 hours every
8 hours

49. Pregnancy
Chloroquine is safe
 Primaquine should be avoided
 instead chloroquine should be
continued at a dose of 310 mg each
week during the pregnancy.


50. Chloroquine-resistant benign
malaria

We use,
◦ Quinine
◦ Atovaquone / Proguanil
◦ Artemether / Lumefantrine

51. Prevention
Avoid Mosquito Bite
 Preventive Medicine

◦ Varies area to area
 In our region Chemoprophylaxis is not
recommended

52. References
BNF 61
 www.cdc.gov/malaria
 www.who.int/topics/malaria
