Completion of Treatment

Complicated malaria should be treated for a total of

7 days. Mefloquine can be given as a single dose when oral drugs can be tolerated, since therapeutic blood levels last for a week. Dosages of other oral medications indicated after intravenous.

Uncomplicated malaria requires 3 days of chloroquine treatment in susceptible infections. Oral mefloquine or halofantrine can be used in resistant cases. If P. vivax or P. ovale were identified or suspected, "radical" cure to eradicate hypnozoites

is indicated.

• Patients who require primaquine should be screened for G-6-P-D deficiency before treatment; patients with mild variants of G-6-P-D deficiency can receive primaquine phosphate 0.75 mg of base per kilogram (maximum 45 mg) once weekly for 6 weeks. Primaquine should not be given during pregnancy.

• Tetracycline should not be given to pregnant women or to children < 8 years of age.

• Treatment with mefloquine is associated with very infrequent neuropsychiatric side effects. This drug should not be used by children of weight < 15 kg, by pregnant women, by persons with underlying cardiac conduction abnormalities who are taking beta blockers, or by patients with a history of psychiatric or seizure disorders. Be cautious while administering mefloquine to persons requiring critical motor skills, such as pilots

• Halofantrine should not be given to persons with underlying cardiac conduction abnormalities or a long ECG-QT interval.

• Infusion should be stopped temporarily if the electrocardiograph QRS interval is prolonged by > 50 per cent of the baseline or the QT instead is prolonged by > 25 per cent of the baseline; oral treatment should be substituted for parenteral treatment when the patient can swallow satisfactorily.

• Naso-gastric administration of oral anti-malarials should be attempted if parenteral treatment is not possible, pending transfer to a hospital.

  Tropical spleenomegaly syndrome

  It is a feature of acute attacks of malaria in non-immune patients. This condition is due to an aberrant immunological response to repeated infection by any of the malarial parasite.

  It should be distinguished from other causes of chronic painless, massive spleenomegaly including (1) Leukemia, (2) Lymphoma, (3) Myelofibrosis, (4) Thalassaemias , (5) Haemoaglobinopathies.

  Prolonged anti-malarial chemo-prophylaxis is the most important element in treatment. Spleenectomy is not indicated in this condition.

1. Sporontocidal (Proguanil, Pyrimethamine, Atovaquone), 2. Hypnozoitocidal (Primaquine)

3. Tissue schizontocidal (Proguanil, Pyrimethamine), 4. Blood Schizontocidal (Chloroquine, Quinine Artemesinin), 5. Gametocytocidal (Primaquine, Chloroquine)