Diseases & National Health Programme
Some important changes which have been brought about in the new policy include no presumptive T/t as it may lead to development of chloroquin resistence. In addition:
a. All clinical suspected cases should preferably be investigated for malaria by Microscopy or Rapid Diagnostic Kit (RDK).
b. The first line of treatment is chloroquine and the ACT (Artesunate + Sulpha Pyrimethamine) combination is recommended for the treatment of Pf cases in qualified areas like chloroquine resistant areas, cluster of Blocks and identified districts on the basis of epidemiological situation.
c. Pf cases should be treated with chloroquine in therapeutic dose of 25 mg/kg body weight divided over three days. This practice is to be followed at all levels including VHWs like FTDs/ASHA as well in chloroquine sensitive areas. In high risk area in addition to chloroquine, single dose of Primaquine 0.75 mg/kg bw should be given on first day.
d. Microscopically positive Pv cases should be treated with chloroquine in full therapeutic dose of 25 mg/kg body weight divided over three days. This practice is to be followed at all levels including VHWs like FTDs/ASHA etc. Primaquine should be given in dose of 0.25mg/kg bw daily for 14 days as per prescribed guidelines only to prevent relapse except in contraindicated patients which include G6PD patients, infants and pregnant women.
e. Artesunate tablets should not be administered as mono therapy. It should invariably be combined with sulpha pyrimethamine tablets in prescribed dosages.
f. 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 individual patients should be reported to concerned District Malaria /State Malaria Officer/ROHFW Pf monitoring teams for monitoring of drug sensitivity status.
g. In cases resistant to chloroquine and SP-ACT, oral quinine with tetracycline or doxycline can be prescribed.
h. In severe and complicated P. falciparum malaria cases intra-venous Quinine/ parenteral Artemisinine derivatives are to be given irrespective of chloroquine resistance status. This treatment may continue till such time oral Quinine/Artemesinine derivatives become available.