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Treatment
P. vivax forms hypnozoites in the hepatocytes that stay dormant: may relapsing
P. falciparum P. vivax
16-32 merozoites/schizont
12-24 merozoites/schizont
Fever Pattern..
Uncomplicated Malaria
Signs and Symptoms
Anamnesis:
• Fever, shivering, headache,
diarrhea
• Resides in malaria endemic
area
• History of travelling to malaria
endemic area: 1-4 weeks
before
Pemeriksaan Fisik:
Temp > 37.5 0C
Hepato + splenomegali + Apus Darah Malaria Positif
Pale….
NO SEVERE SIGNS
P. vivax Infections
• Recrudescence: activation of Pv
hypnozoites
Pf • Simultaneous or near Pv
simultaneous
• Subpatent P. vivax parasitaemia
20-50%
Pf treated with short half life drug: 53.8% had Pv recurrence in 63 days
Pf treated with long half life drug: 21.1% had Pv recurrence in 63 days
Pf
Pm
Timika, 2004-2013
P. malariae
Slow replication
Low parasitaemia for a long time:
chronic
Proportion in Timika: 2.6% of all
malaria
Artesunate-
Amodiaquine
Artemether-
Lumefantrine
DHA- DHP
Piperaquine
Indonesia DHA-Piperaquine
Vanuatu Artemether-Lumefantrine
PNG Artemether-Lumefantrine
Treatment Protocol
Kemenkes, 2009
• Uncomplicated P. falciparum and P. vivax malaria:
– First line: DHP (DHA 40 mg and PPQ 320 mg) for 3 days
• DHA 2-4 mg/kgBB/dose
• PPQ 16-32 mg/kgBB/dose
– Second line: Q7C7
– Primaquine:
• Pf single dose 0.75 mg base/kgBB
• Pv dan PO 0.25 mg base/kgBB for 14 days
• Bayi < 5 kgs:
– Q7C7
– Primaquine is not given to infants < 1 year old
• Severe Malaria:
– Artesunate (60 mg artesunate per vial) iv 2.4 mg/kgBB on 0, 12
and 24 hours and then every 24 hours until patient can tolerate
oral antimalarial drug (intravenous therapy should be minimal 24
hours)
– Continues with DHP/AAQ for 3 days
WHO 2010 and Kemenkes WHO 2015 and Kemenkes
2009 2017
Uncomplicated P. falciparum
and P. vivax malaria:
Uncomplicated P. falciparum
and P. vivax malaria:
DHP (DHA 40 mg and PPQ 320
mg) for 3 days
DHP (DHA 40 mg and PPQ 320
• DHA 2-4 mg/kgBB/dose mg) for 3 days
• PPQ 16-32 mg/kgBB/dose
• Children < 25 kg BW: minimum
DHA 2.5 mg/kg BW and PPQ 20
Infants < 5 kgs: mg/kg BW per day
– Q7C7
– Primaquine is not given to Infants < 5 kgs:
infants < 1 year old – DHP = 5 kgs infant’s
dosing
– Primaquine is not given to
infants < 6 months old
(unless G6PD status is
known)
WHO 2010 and Kemenkes WHO 2015 and Kemenkes
2009 2017
Primaquine: Primaquine:
• Pf single dose 0.75 mg • Pf single dose 0.25 mg
base/kgBB base/kgBB
• Pv dan PO 0.25 mg base/kgBB • Pv dan PO 0.25 mg base/kgBB
for 14 days for 14 days
Except for: Except for:
Pregnant women, Infants aged < Pregnant women, Infants aged <
1 year old, Women breastfeeding 6 months old, Women
infants’ G6PD deficient patient breastfeeding infants, G6PD
deficient
G6PD deficient:
• Consider primaquine 0.75 mg/kg
BW once a week for 8 weeks
• Close medical supervision for
potential induced hemolysis
WHO 2010 and Kemenkes WHO 2015 and Kemenkes
2009 2017
Severe Malaria:
Severe Malaria:
• Artesunate (60 mg artesunate
per vial) iv 2.4 mg/kgBB on 0,
12 and 24 hours and then Children weight < 20 kgs:
every 24 hours until patient • Artesunate 3 mg/kg BW per
can tolerate oral antimalarial dose on 0, 12 and 24 hours
drug (intravenous therapy and then every 24 hours until
should be minimal 24 hours) patient can tolerate oral
antimalarial drug (intravenous
therapy should be minimal 24
• Continues with DHP/AAQ for 3 hours)
days
• Continues with DHP/AAQ for 3
days
Core Principles
1. Early diagnosis and prompt effective
treatment:
– Access to early diagnosis and treatment
within 24-48 hours after the onset of malaria
symptoms
2. Rational use of antimalarial agents
3. Combination therapy
4. Appropriate weight-based dosing
Thrombocytopenia
• Frequently found in vivax and falciparum
malaria: cam be < 20,000 cells/μL
• Immune mechanism to malaria: TNF α
• Rarely cause hemostasis disturbance
• Resolved following an effective malaria
treatment
Thank You