What are the treatment guidelines for different types of malaria, including Plasmodium (P.) vivax and Plasmodium (P.) falciparum, in adults and children in West Bengal, India?

From the Guidelines

The treatment for malaria in West Bengal, India, should follow the guidelines based on the type of malaria infection, with Artemisinin-based Combination Therapy (ACT) recommended for uncomplicated Plasmodium falciparum malaria, and Chloroquine followed by Primaquine for Plasmodium vivax malaria, as per the most recent guidelines 1.

Uncomplicated Malaria Treatment

For uncomplicated Plasmodium falciparum malaria in adults, the recommended treatment is ACT, which includes Artesunate (4 mg/kg body weight) once daily for 3 days plus Sulfadoxine (25 mg/kg) and Pyrimethamine (1.25 mg/kg) as a single dose on the first day. For children, the dosage is adjusted by weight, with Artesunate at 4 mg/kg daily for 3 days and weight-appropriate doses of Sulfadoxine-Pyrimethamine.

• For Plasmodium vivax malaria, the standard treatment for both adults and children is Chloroquine at 25 mg/kg divided over 3 days (10 mg/kg on day 1,10 mg/kg on day 2, and 5 mg/kg on day 3), followed by Primaquine for 14 days (0.25 mg/kg daily for adults and 0.25 mg/kg daily for children) to prevent relapse by eliminating liver stages, as suggested by recent studies 1.
• In cases of mixed infections, ACT is recommended followed by Primaquine.

Severe Malaria Treatment

Severe malaria requires immediate hospitalization with intravenous Artesunate (2.4 mg/kg as initial dose, then at 12 hours, 24 hours, and then once daily) until oral therapy can be tolerated. Primaquine should be avoided in pregnant women and G6PD-deficient patients due to risk of hemolysis. Treatment should begin immediately after diagnosis to prevent complications like cerebral malaria, which can be fatal, especially in P. falciparum infections.

Considerations

• The use of ACTs is endorsed by WHO and CDC for uncomplicated malaria in any trimester of pregnancy 1.
• For patients in whom ACTs are contraindicated, or those coming from areas with high levels of resistance to ACTs, a second-line drug such as atovaquone-proguanil should be used for the treatment of uncomplicated P. falciparum malaria.
• Post-artemisinin delayed haemolysis (PADH) is a serious adverse event associated with ACTs, and its risk should be considered when treating patients with these drugs 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Malaria Treatment in Adults Treatment of mild to moderate malaria in adults caused by mefloquine-susceptible strains of P. falciparum or by P. vivax: Dosage: Five tablets (1250 mg) mefloquine hydrochloride USP to be given as a single oral dose. Malaria Treatment in Pediatric Patients Treatment of mild to moderate malaria in pediatric patients caused by mefloquine-susceptible strains of P. falciparum: Dosage: 20 to 25 mg/kg body weight. For treatment of uncomplicated P. falciparum malaria in adults: Orally, 648 mg (two capsules) every 8 hours for 7 days

The treatment guidelines for different types of malaria are as follows:

• Malaria Treatment in Adults:
  • For mefloquine-susceptible strains of P. falciparum or P. vivax, the dosage is 1250 mg mefloquine hydrochloride USP as a single oral dose 2.
  • For uncomplicated P. falciparum malaria, the dosage is 648 mg quinine sulfate capsules every 8 hours for 7 days 3.
• Malaria Treatment in Pediatric Patients:
  • For mefloquine-susceptible strains of P. falciparum, the dosage is 20 to 25 mg/kg body weight 2. Note that these guidelines are based on the provided drug labels and may not be comprehensive or applicable to all situations.

From the Research

Treatment Guidelines for Malaria in India, West Bengal

Adult Treatment

• For uncomplicated P. falciparum malaria, the World Health Organization recommends Artemisinin-based Combination Therapy (ACT) 4.
• ACTs such as dihydroartemisinin-piperaquine, artesunate plus mefloquine, and artemether-lumefantrine are effective in treating uncomplicated P. falciparum malaria 4.
• For uncomplicated P. vivax malaria, ACTs are at least equivalent to chloroquine in effectively treating the blood stage parasite 5, 6.
• Dihydroartemisinin-piperaquine may provide a longer period of post-treatment prophylaxis than artemether-lumefantrine or artesunate plus amodiaquine 5, 6.

Child Treatment

• The treatment guidelines for children with malaria are similar to those for adults, with ACTs being the recommended treatment for uncomplicated P. falciparum and P. vivax malaria 4, 5, 6.
• However, the dosage and duration of treatment may vary depending on the child's age and weight.

Specific Treatment Regimens

• For uncomplicated P. vivax malaria, a 7-day primaquine regimen at 0.50 mg/kg/day may be effective in preventing relapses, as compared to the standard 14-day regimen at 0.25 mg/kg/day 7.
• The Indian National Center for Vector Borne Diseases Control (NCVBDC) recommends treatment with primaquine at a dose of 0.25 mg/kg/day provided over 14 days to prevent relapses 7.

Key Considerations

• The choice of treatment regimen should be based on the specific type of malaria, the patient's age and weight, and the presence of any underlying medical conditions.
• It is essential to follow the recommended treatment guidelines and dosages to ensure effective treatment and prevent the development of resistance to antimalarial drugs.
• Further research is needed to determine the most effective treatment regimens for malaria in different regions and populations 8.