Malaria-Medicines For Treatment,Dosage,Side Effects,Prevention.
There are several medicines that can fight malaria; unfortunately, in many parts of the world, malaria parasites have become resistant to the best malaria medicines. This is especially true for the most serious type of malaria (falciparum malaria).
Malaria is an infection of the blood that causes chills and high fever. Malaria is spread by mosquitos. The mosquito sucks up the malaria parasites in the blood of an infected person and injects them into the next person it bites.
SIGNS OF MALARIA ( The typical attack has 3 stages) :
- It begins with chills and often headache and weakness. The person shivers or shakes for 15 minutes to an hour.
- Chills are followed by fever, often 40 degrees or more. The person is weak and at times delirious (not in his or her right mind). The fever lasts several hours or days.
- Finally the person begins to sweat and his temperature goes down.
- Usually malaria causes fever every 2 or 3 days (depending on the kind of malaria) but in the beginning, it may cause fever daily. Also, the fever pattern may not be regular or typical. For this reason, anyone who suffers from unexplained fevers should have his or her blood tested for malaria.
- Chronic malaria often causes a large spleen and anemia.
- In young children, anemia and paleness can begin within a day or two. In children with malaria affecting the brain (cerebral malaria), fits may be followed by periods of unconsciousness. Also, the palms may show a blue-gray color and breathing may be rapid and deep. Note that children who have not been breast fed are more likely to get malaria.
It is important to learn from the health department or at a health center; what medicine work best in your area. New medicines are being developed, but these are only likely to be effective for a limited time before resistance to them develops.
NOTE : Malaria can quickly kill persons who have not developed immunity. Children and people who visit areas with malaria must be treated immediately.
- If you suspect malaria or have repeated fevers, if possible go to a health center for a blood test.
- If chloroquine is usually effective and tablets with 150 mg base are used, adults should take 2 tablets twice a day for 3 days. Chloroquine tablets starts to work within 30 minutes. There is no need to begin with a chloroquine injection. The fever will settle in a day or two. Just complete the course of tablets.
- In some places, there is malaria resistant to chloroquine and a different medicine like Fansidar or quinine may be needed. Get advice from the nearest health center.
- If a person who possibly has malaria begins to have convulsions or loss of consciousness, he or she may have cerebral malaria. Get to a health center urgently for an antimalarial injection.
Medicines for malaria can be used in two ways
- TREATMENT of the person who is ill with malaria. Medicine is given daily for just a few days.
- PREVENTION : To keep any malaria parasites that may be in the blood from doing harm.
Prevention is used in areas where malaria is common, especially to protect children who are weak or sick for other reasons. It is also used by persons visiting a malaria area who have no defenses against the disease. Medicines are usually given weekly. To prevent malaria, also be sure to follow the advice on how to avoid mosquito bite.
Certain malaria medicines are used only to treat attacks of malaria while some only work for prevention. Others can be used for both.
As of 1993, Chloroquine is still the most useful medicine to prevent and treat malaria, but widespread resistance is likely to develop as it has in parts of the world. Chloroquine resistance is already widespread in East Africa. Quinine is usually the best medicine to treat severe malaria in an area where resistance is likely or to treat malaria affecting the brain.
Mefloquine is also a medicine used to prevent and treat malaria that is resistance to chloroquine. Fansidar is another medicine for treating malaria resistant to chloroquine. Proguanil is used with chloroquine for prevention. Tetracycline is also used occasionally in malaria treatment and prevention.
Chloroquine comes in two forms, chloroquine phosphate and chloroquine sulfate. The doses are different but, tablet for tablet, the amount of chloroquine base in each is the same.
Chloroquine phosphate(Resochin, Avlochlor, Aralen), 250 mg tablet, has 150 mg chloroquine base.
Chloroquine sulfate(Nivaquine), 200 mg tablet also has 150 mg chloroquine base.
So the dose must either be given in terms of the amount of chloroquine base or more easily in terms of the number of tablets in relation to weight or age. People who have grown up in areas where malaria is very common and have survived generally have malaria parasites in their bodies, but show no symptoms except when exposed to excessive strain, cold or exertion. They are said to be semi-immune when they have a malaria breakthrough, they do not need heavy dose initially as those who pick up the disease on a temporary visit and need medical treatment.
Chloroquine causes marked itching all over in some people. It may also cause blurred vision particularly on full dosage.
DOSAGE OF CHLOROQUINE BY MOUTH
For radical treatment of acute attacks of malaria; for the first dose, give :
- Adults : 2 tablets(600 mg base)
- Children between 10 to 15 years old : 3 tablets
- Children between 6 to 9 years old : 2 tablets
- Children between 3 to 5 years old : 1 tablet
- Children between 1 to 2 years old : ½ tablet
The second dose should be 6 hours after the first and half the amount should be given. Repeat again for the next 2 days.
- Adults : 2 tablets(300 mg base)
- Children between 10 to 15 years old : one and half tablets
- Children between 6 to 9 years : one tablet
- Children between 3 to 5 years old : half tablet
- Children between 1 to 2 years old : quarter tablet (¼)
For children, chloroquine syrup with 50 mg base in 5 ml (1 teaspoon) is often used. One and half teaspoons equals half tablet.
For treatment of semi-immune patients with a breakthrough :
Adults : 2 tablets twice a day for 2 to 3 days
Children : Reduce dose accordingly
FOR PREVENTION OF MALARIA
Give once a week, beginning 1 week before and continuing for 4 weeks after leaving a malaria area.
- Adults : 2 tablets(400 mg)
- Children between 10 to 15 years old : one and half tablets(300 mg)
- Children between 6 to 9 years old : 1 tablet(200 mg)
- Children between 3 to 5 years old : ½ tablet(100 mg)
- Children between 1 to 2 years old : ¼ tablet(50 mg)
- Babies under 1 year : 1/8 tablet(25 mg)
FOR TREATMENT OF LIVER ABSCESS CAUSED BY AMEBAS :
Using tablets of 250 mg, chloroquine phosphate or 200 mg chloroquine sulfate
- Adults : 3 or 4 tablets twice a daily for 2 days and then one and half or two tablets daily for three weeks. Give children less according to age or weight.
QUININE(quinine sulfate or quinine bisulfate)
This medicine is used to treat resistant malaria (malaria that does not get better with other medicines and also severe malaria, including malaria that affects the brain. It is best given by mouth but if vomiting is a problem when giving by mouth, a medicine such as promethazine may help.
Quinine comes in tablets of 300 mg or 650 mg
Quinine sometimes causes sweaty skin, ringing of the ears or impaired hearing, blurred vision, dizziness, nausea and vomiting, diarrhea.
DOSAGE OF QUININE FOR TREATING ACUTE ATTACKS OF MALARIA
Using tablets of 300 mg; Give 3 times a day for 3 days
- Adults : 2 tablets (600 mg)
- Children between 10 to 15 years old: One and half tablets (450 mg)
- Children between 6 to 9 years old : One tablet (300 mg)
- Children between 3 to 5 years old : Half tablet (150 mg)
- Children between 1 to 2 years old : ¼ tablet (75 mg)
- Babies under 1 year old : 1/8 tablet (38 mg)
WHEN TO GIVE INJECTIONS OF QUININE OR CHLOROQUINE
Injections of quinine or chloroquine should be given only rarely, in cases of great emergency. If a person who shows signs of malaria or lives in an area where there is a lot of malaria is vomiting, having fits (convulsions), or showing other signs of meningitis, he may have cerebral malaria (malaria in the brain). Inject quinine at once. But if you don’t have other medicines available, try injecting chloroquine. Great care must be taken to be sure the dose is right. You can as well seek medical help.
QUININE DIHYDROCHLORIDE INJECTIONS
This medicine comes in 300 mg in 2 ml. Quinine injections should be given slowly and never directly into the vein. This can be dangerous to the heart. Make sure you take great care with children.
Inject half this dose slowly into each buttock. Before injecting, draw back on the plunger; if blood appears, inject in another site. Repeat the same dose 12 hours later.
- Adult : 600 mg (2 ampules of 2 ml)
- Children : 0.07 ml (1/18 ml or 10 mg) for each kg the child weighs.
- A one year old baby who weighs 10 kg would get 0.70 ml
This comes in 200 mg in 5 ml. Give the dose once only (inject ½ into each buttock) :
- Adults : 200 mg (the entire ampule of 5 ml)
- Children : Inject 0.1 ml (1/10 ml) for each kg the child weighs
- A one year old baby who weighs 10 kg would get 1 ml
The dose may be repeated 1 day later if improvement has not taken place.
This medicine is also known as Lariam, it comes in tablets of 250 mg. Mefloquine can prevent and stop acute attacks of malaria that is resistant to chloroquine.
Precautions and side effects
Mefloquine should not be taken by pregnant women or persons with epilepsy. Persons with heart or mental problems should get experienced medical advice before taking this medicine. Mefloquine sometimes causes strange behavior, confusion, dizziness, stomach upset, headache, vision problems and occasionally fits or unconsciousness. Take with a large meal. Side effects are more frequent and severe with the higher dose used for treatment.
DOSAGE OF MEFLOQUINE
For treatment of acute attacks of malaria : Give one time:
- Adults : 5 tablets (1250 mg)
- Children between 12 to 15 years old : 4 tablets (1000 mg)
- Children between 8 to 11 years old : 3 tablets (750 mg)
- Children between 5 to 7 years old : 2 tablets (500 mg)
- Children between 1 to 4 years old : 1 tablet (250 mg)
- Babies under 1 year old : ½ tablet (125 mg)
For prevention of malaria :
Give once a week, continue until 4 weeks after leaving malaria
- Adults : 1 tablet (250 mg)
- Children over 45 kg : 1 tablet (250 mg)
- Children between 31 to 45 kg : ¾ tablet (188 mg)
- Children between 20 to 30 kg : ½ tablet (125 mg)
- Children between 15 to 19 kg : ¼ tablet (62 mg)
- Children under 15 kg : Not recommended
PYRIMETHAMINE WITH SULFADOXINE
This medicine is also known as fansidar, it comes in combination tablet with 25 mg pyrimethamine and 500 mg sulfadoxine. Fansidar is used to treat resistant malaria.
WARNING : Fansidar should not be taken by anyone who has ever had a reaction to a sulfa medicine. If the medicine causes a rash or itching, drink lots of water and do not take it again.
DOSAGE TO TREAT ACCUTE ATTACKS OF MALARIA:
Give one time :
- Adult : 3 tablets
- Children between 9 to 14 years old : 2 tablets
- Children between 4 to 8 years old : 1 tablet
- Children between 1 to 3 years old : ½ tablet
- Babies under 1 year old : ¼ tablet
This medicine is also known as paludrine, it often comes in tablets of 100 mg. Proguanil is taken with chloroquine for prevention of chloroquine resistant malaria. Proguanil is not used to treat acute attacks of malaria.
DOSAGE OF PROGUANIL FOR PREVENTION
Give medicine each day, starting the day you entered a malaria area until 28 days after leaving the area.
- Adults : 2 tablets (200 mg)
- Children between 9 to 14 years old : One and half tablets (150 mg)
- Children between 3 to 6 years old : 1 tablet (100 mg)
- Children between 1 to 2 years old : ½ tablet (50 mg)
- Babies under one year old : ¼ tablet (25 mg)
This medicine often comes in tablets of 26.3 mg of primaquine phosphate, which contains 15 mg of primaquine base. Primaquine is usually used after treatment with chloroquine or another malaria medicine to keep some kinds of malaria from coming back. Primaquine does not work by itself for acute attacks.
Pregnant women should not take primaquine. In certain persons especially some black people, this medicine ccauses anemia to them. Make sure you seek medical advice.
DOSAGE OF PRIMAQUINE
Give once a day for 14 days, in each dose give:
- Adults : 1 tablet (15 mg base)
- Children between 8 to 12 years old : ½ tablet (7 mg base)
- Children between 3 to 7 years old : ¼ tablet (4 mg base)
Tetracycline can be used to treat acute attacks of malaria in some areas where there is much chloroquine resistant malaria. But because it works slowly, it should be given with another medicine (usually quinine). People visiting these areas sometimes take doxycycline daily for prevention
HOW TO AVOID MALARIA AND DENGUE
Malaria occurs more often during hot, rainy seasons. If everyone cooperates, it can be controlled. All these control measures should be practiced at once.
- Avoid mosquitos. Sleep where there are no mosquitos or underneath a sheet. Cover the baby’s cradle with mosquito netting or a thin cloth. Netting treated with insecticide works better.
- Cooperate with the malaria control workers when they come to your area. Tell them if anyone in the family has had fevers and let them take blood for testing.
- If you suspect malaria, get treatment quickly. After you have been treated, mosquitos that bite you will not pass malaria on to others.
- Destroy mosquito and their young. Mosquitos breed in water that is not flowing : clear ponds, pits, old cans or broken pots that collects water. Drain or put a little oil on pools or marshes where mosquitos breed. Fill the tops of bamboo posts may be with sand to avoid the breeding of mosquito on the bamboo top.
- Malaria can also be prevented, or its effects greatly reduced by taking anti-malaria medicines on a regular schedule