National Malaria Drug Policy

8/8/2019 National Malaria Drug Policy

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NATIONAL DRUG POLICY

ONMALARIA(2010)


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Objectives of National Drug Policy

Access: equitable availability and affordabilityof essential drugsQuality: safety and efficacy of all medicinesRational use: the promotion of therapeuticallysound and cost effective use of drugs by healthprofessionals and consumers.


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National Drug Policy on Malaria

The main purpose of National Drug Policy onMalaria is to provide a framework for the safe andeffective treatment of uncomplicated and severemalaria as well as prevention of malaria intravelers and vulnerable groups, such as pregnantwomen and young children.


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National Drug Policy on Malaria

First formulated in 1982Reviewed and revised periodically

Aims at:Providing complete cure (clinical & parasitological).Preventing progression into severe malaria.

Prevention of relapses.Interruption of transmission.Preventing development of resistance.


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Criteria for change of Drug Policy

Drug policy is changed for the area/Block PHCreporting 10% or more total treatment failure(ETF+LTF) to the tested drug i.e. the currently usedantimalarials in a sample of minimum 30P.falciparum test cases.


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Diagnosis

All fever cases suspected to be malaria should be investigated by:Microscopy:Sensitive, parasite load can be estimatedPossible to distinguish different speciesRapid Diagnostic Test (RDT):Detect malaria antigen (HRP-2/pLDH)Should be provided in remote locations

In cases where parasitological diagnosis is not possible due to non-availability of microscopy or RDT, suspected malaria cases will be treatedwith full course of chloroquine till the result of microscopy are received.


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Treatment of P. Vivax cases

1. Chloroquine X 3 days 10 mg/kg on days 1 & 2followed by 5 mg/kg on day 3

2. Primaquine X 14 days 0.25 mg/kg


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Presumptive treatment with Chloroquine is notrecommended


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Age inyears

Tablet Chloroquine (150 mg base)

Day 1 Day 2 Day 3

TabletPrimaquine

(2.5 mg base)

Day 1 to Day 14

< 1 01 - 4 1 1 1

5 - 8 2 2 1 2

9 - 14 3 3 1 4

15 & above 4 4 2 6


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Treatment of P. FalciparumArtemisinin based combination therapy (ACT)

Day 1

Artesunate4mg/kg BW

Sulfadoxine(25mg/kg BW) +

Pyrimethamine(1.25 mg/kg BW)

Day 2

Artesunate4mg/kg BW

Primaquine0.25 mg/kg BW

Day 3

Artesunate4mg/kg BW


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Age wise dosage schedule forP.Falciparum cases

Age inyears

Day 1 Day 2 Day 3

Artesunate(50 mg)

S+P(500+25)

Artesunate(50mg)

Primaquine(7.5mg base)

Artesunate(50 mg)

< 1 0

1 4 1 1 1 1 1

5 8 2 1 2 2 2

9 14 3 2 3 4 3

15 & above 4 3 4 6 4


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Treatment of uncomplicatedP. Falciparum cases in pregnancy

1 st Trimester

Quinine10mg/kg BW

tid X 7 days

2nd Trimester

ACT as perschedule

3 rd Trimester

ACT as perschedule


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Treatment of severe Malaria cases

Drug Dosage Route Remarks

Artesunate 2.4 mg/kg BW IV / IM 0h,12h,24h od


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Artemether3.2 mg/kg BW

1.6 mg/kg BWIM od


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1.6 mg/kg BWIM od

Arteether 150 mg IM od X 3 days


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1.6 mg/kg BWIM od

Arteether 150 mg IM od X 3 days

Quinine

Quinine+Doxycyclin

OrClindamycin

20 mg/kg BW

10 mg/kg BW

10 mg/kg BW3mg / kg BW

10mg/kg BW

IV / IM

Oral

tid

tid X 7 daysod X 7 days

bd X 7 days

ACT for 3 days after parenteral therapy


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Chemoprophylaxis

Only in selective groups in high pf endemic areas.Short term (up to 6 wks): Doxycyclin 100mg od 2days before travel & continued 4 weeks afterleaving malarious area.Long term (more than 6 wks) : Mefloquine 250 mgweekly 2 weeks before & 4 weeks after exposure.


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THANK YOU


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Epidemiological Profile : India (2008)

Total Population : 1091 millionPopulation in malarious areas : 981.9 million

No. of lab confirmed cases : 1.53 millionPf proportion : 50%No. of deaths due to malaria : 1061High transmission areas: 26%Low transmission areas: 64%Malaria free: 10%


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Malaria Situation in India

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Chloroquine Resistant Areas (1978-2008 August)

Documents

National Malaria Drug Policy