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Management and Treatment

Of Malaria

Referensi:
Sub Dit Pengendalian Malaria,
KEMENKES RI, 2008
INTRODUCTION
Malaria GLOBAL PROBLEM
Global Commitment
to eliminate malaria in every country
25 April 2011, Malaria World Day
theme (Malaria Free, Nation Investment)
in INDONESIA Commit to Eliminate Malaria
it was decided that 3 main components
should be available in area of elimination
1. ACT,
2. Rapid Diagnostic Test,
3. Long lasting Insectized Net (LLIN)
Referensi:
Sub Dit Pengendalian Malaria, KEMENKES RI, 2008
Target of elimination
Step Year Target place of elimination

Step I 2010 Jakarta province, Seribu


Island, Bali and Batam
Step II 2015 Jawa island, Aceh, and
Riau
Step III 2020 Sumatra, West Nusa
Tenggara , Kalimantan, and
Sulawesi
Step IV 2030 Papua, East Nusa
Tenggara, Maluku
Referensi:
Sub Dit Pengendalian Malaria, KEMENKES RI, 2008
Program strategy

Diagnosis
all malaria cases must be confirm with
microscope or rapid diagnostic test
STOP CLINICALLY
DIAGNOSTIC
Therapy
Artemisinin based combination therapy
STOP MONOTHERAPY
Referensi:
Sub Dit Pengendalian Malaria, KEMENKES RI
Clinical manifestation
Incubation: P.falciparum, 8-15 days,
P.vivax and P.ovale 10-15 days,
P.malariae 30-40 days
Prodromal sign: Fever, headache , muscle
pain, weakness
Fever (relapsing)
- P.vivax and P. ovale /3 days tertiana),
- P.malariae/4 days (quartana),
- P. falciparum /2 days
Specific sign of malaria

Paroxysmal attack : chill (15 minute)- high

fever 40 C (2-6 hours)-sweating (1-2 hours)

normal

Anemia, hemoglobinuria, Splenomegali,

Hepatomegali,

P.vivax relaps, P.falciparumrecrudescence


MALARIA PERNISIOSA:
P.falcifarum + complication

CEREBRAL MALARIA
NEUROLOGIC SYMPTOMS, COMA
RENAL COMPLICATION
Acute renal faillure
PULMONAL COMPLICATION
acute respiratory distress syndrome=ARDS
GI Tract complication
Severe icterus (billious remittent fever)
diarrhea (cholera or dysentri like diarrhea)
BLACK WATER FEVER
Hemoglobinemia, hemoglubinuria
Malaria Treatment
Plasmodium falsifarum
1.A. Firsline anti-malaria therapy
Artesunat + Amodiaquin + Primaquin

Single dose, for 3 days, after meal


Amodiakuin base = 10 mg/kgbb
Artesunat = 4 mg/kgbb
Primakuin = 0.75 mg/kgbb

Referensi:
Sub Dit Pengendalian Malaria, KEMENKES RI
1.B. Other First line anti-malaria therapy

Dihidroartemisinin + Piperaquin + Primakuin


At this time this regimen only use for Papua area

Fist line treatment Falcifarum Malaria using


Dihidroartemisin and Piperaquin (DHP) + Primakuin

Day Type of Number of tab/day according to the age


drug
0-1 m 2-11 m 1-4 years 5-9 10-15 15
years years years
1 DHP 1 1.5 3 3-4
Primakuin 1.5 2 2-3
2-3 DHP 1 1.5 2 3-4
Doses of the drug
dihydroartemisinin = 2-4 mg/kgBB
piperaquin = 16- 32 mg/kgBB
primaquin = 0.75 mg/kgBB

Referensi:
Sub Dit Pengendalian Malaria, KEMENKES RI, 2008
2. Second line drug for P. falcifarum
Kina + Doksisiklin or Tetracycline +Primakuin

Day Type of Number of tab/day according to the age


drug
0-11 m 1-4 years 5-9 years 10-14 years > 15 years

1 Kina * 3x1/2 1 3x1.5 3x2-3


Doksisiklin - - 2x1** 2x1***
primakuin - 2 2-3

2-7 Kina * 3x1/2 1 3x1.5 3x2-3

Doksisiklin - - - 2x1** 2x1***

* Dosage according to BW, ** 2x 50 mg, ***, 2x 100mg


3. Second line drug for P. falcifarum

Day Type of drug Number of tab per day according to age

0-11 m 1-4 y 5-9 y 10-14 y 15 y

1 Kina * 3x1/2 3x1 3x1 3x(2-3)


Tetracycline - - - * 4x (250 mg

Primakuin - 1 2 2-3

2-7 Kina * 3x 3x1 3X1 3x(2-3)

Tetracycline - - - * 4x 250 mg
Treatment of Malaria vivax, ovale
and malariae
First line treatment ACT
Same with falcifarum malaria
The difference:
primakuin is given for 14 days
Second line treatment of Malaria
vivax, ovale and malariae
Combination: Kina tablet and primakuin
dosage : kina 30 mg/kgBW/day
7 days
primakuin 0.25 mg/kgBW/day
14 days
Malaria in Dr.Soetomo Hospital
In the year 2012
There were 12 patients admitted (malaria import)
P falciparum 4 (33.33%)
P vivax 2 (16.66%)
Clinically (Plasmodium not detected): 6 (50%)
Death 1 patient
PRINSIPLE OF MALARIA
PREVENTION
Information of the disease (malaria):
clinical sign and symptoms, malaria drug,
resistance)
Prevention mosquito biting
Use medicine if necessary : depend on the
resistant pattern
Quick and prompt treatment of malaria:
drug should be available