Clinical (palliative) chemoprophylaxis of malaria. Community prevention of malaria
Mechanisms of action on malaria pathogens P. s. different chemicals the buildings are not the same. For example, 4-aminoquinoline derivatives disrupt intracellular metabolic processes in erythrocyte forms of plasmodium, causing amino acid deficiency and the formation of cytolysosomes. Quinine interacts with Plasmodium DNA. 8-aminoquinoline derivatives inhibit the mitochondrial functions of extraerythrocytic forms of plasmodium. Chloridine and sulfonamides disrupt the biosynthesis of folic acid. At the same time, sulfonamides prevent the formation of dihydrofolic acid due to competitive antagonism with n-aminobenzoic acid, and chloridine is an inhibitor of dihydrofolate reductase and disrupts the restoration of dihydrofolic acid to tetrahydrofolic acid.
P.S. used for the treatment and chemoprophylaxis of malaria.
P.S. have unequal activity against different life forms of plasmodia and can have a schizotropic (schizontocidal) effect aimed at the asexual forms of these pathogens, and a hamotropic (gamontocidal) effect aimed at the sexual forms during their development in the human body. In this regard, schizotropic and hamotropic drugs are isolated.
Schizotropic P. s. differ in activity against asexual erythrocyte and extra-erythrocytic forms of malaria pathogens, therefore drugs of this subgroup are divided into histoschizotropic (tissue schizontocides) and hematoschizotropic (blood schizontocides). Histoschisotropic P. s. cause the death of extra-erythrocyte forms: early pre-erythrocyte forms developing in the liver, and forms that remain in the body outside erythrocytes in a latent state during the period preceding the remote manifestations of malaria caused by Plasmodium vivax and Plasmodium ovale. Hematoschizotropic P. s. are active against asexual erythrocyte forms and stop their development in erythrocytes or prevent it.
Gamotropic P. pages, affecting the sexual forms of plasmodia in the blood of persons infected with them, cause the death of these forms (gamontocidal effect) or damage them (gamostatic effect). Gamostatic effect of P. s. in nature it can be disflagellation, i.e., preventing the formation of male gametes as a result of exflagellation of male sexual forms in the stomach of a mosquito and thereby disrupting the subsequent fertilization of female sexual forms, or late hamostatic (sporontocidal), i.e., preventing the completion of sporogony and formation sporozoites (see Malaria).
According to chemistry structure among P. s. distinguish: 4-aminoquinoline derivatives - hingamine (see), nivaquin (chloroquine sulfate), amodiaquine, hydroxychloroquine (plaquenil); diaminopyrimidine derivatives - chloridine (see), trimethoprim; biguanide derivatives - bigumal (see), chlorproguanil; derivatives of 9-aminoacridine - akriquin (see); 8-aminoquinoline derivatives - primaquine (see), quinocide (see); sulfonamides - sulfazine (see), sulfadimethoxine (see), sulfapyridazine (see.
), sulfalene, sulfadoxine; sulfones - diaphenylsulfone (see). As a P. s. Quinine preparations are also used (see) - quinine sulfate and quinine dihydrochloride. According to the type of action, derivatives of 4-aminoquinoline, 9-aminoacridine, sulfonamides, sulfones and quinine preparations are hematoschizotropic. Derivatives of diaminopyrimidine (chloridine, trimethoprim) and biguanide (bigumal, chlorproguanil) are histoschisotropic and are active against early pre-erythrocytic tissue forms developing in the liver.
Features of action and classification of antimalarial drugs
In areas where there are no drug-resistant pathogens, one of the drugs is usually prescribed for treatment: 4-amino-quinoline derivatives (quinamine, amodiaquine, etc.), quinine. For persons with partial immunity to malaria pathogens (for example, adult indigenous residents of endemic areas), these drugs can be prescribed in reduced course doses. In severe cases of tropical malaria, quinine is sometimes prescribed instead of 4-aminoquinoline derivatives. In endemic areas of drug-resistant tropical malaria, treatment is carried out by prescribing combinations of hematoschizotropic drugs, for example, quinine in combination with chloridine and long-acting sulfonamides.
Preliminary treatment (use of P. with. if malaria is suspected) is carried out before diagnosis is made in order to weaken the wedge, manifestations of the disease and prevent possible infection of mosquitoes. To do this, a hematoschizotropic drug is prescribed once, for example, hingamine or quinine (taking into account the sensitivity of local pathogen strains) immediately after taking blood for testing for malaria. If there is a danger of mosquito infection and the possibility of completion of sporogony, hemotropic antimalarial drugs (eg, chloridine, primaquine) are prescribed in addition to these drugs. Once the diagnosis is confirmed, a full course of radical treatment is carried out.
The tactics of using the listed funds in the USSR - see Malaria.
There are three types of chemoprophylaxis for malaria - personal, public and off-season; the choice depends on the goal, the protected contingents, epidemiol. conditions, type of pathogen. Different types of malaria chemoprophylaxis should be confined to specific periods determined by the phenology of the infection.
The groups of people subject to chemoprophylaxis are determined taking into account their vulnerability to malaria infection or the degree of danger as a source of infection. Choice of P. s. depends on the type of chemoprophylaxis carried out, the sensitivity of local strains to P. s. and individual drug tolerance. Doses and prescription regimens P. s. set depending on the characteristics of the pharmacokinetics of the drugs, the dominant type of plasmodium in the area and the degree of endemicity of the zone in which P. s. for chemoprophylaxis.
Personal chemoprophylaxis is aimed at completely preventing the development of the pathogen or preventing attacks of the disease in persons at risk of infection. There are two forms of this type of chemoprophylaxis - radical (causal) and clinical (palliative).
For the purpose of radical chemoprophylaxis of tropical malaria, P. can be used that act on pre-erythrocytic forms of plasmodium, for example, chloridine, bigumal. However, these drugs vary in effectiveness against different strains of the pathogen. For malaria caused by Plasmodium vivax and Plasmodium ovale, these drugs prevent only early manifestations of the disease.
Wedge. chemoprophylaxis is carried out with the help of P. with., acting on erythrocyte forms of plasmodium. In areas where drug-resistant forms of pathogens are not registered, Ch. about the river khingamine and chloridine. The drugs are prescribed throughout the entire period of possible infection, and in highly endemic tropical zones, where malaria transmission can occur continuously, throughout the year. In areas where there are seasonal breaks in the transmission of malaria or during a temporary stay in an endemic zone, drugs are prescribed several days before the onset of possible infection and continue for 6-8 weeks. after the danger of infection has ceased.
Personal chemoprophylaxis can completely prevent the development of tropical malaria caused by Plasmodium falciparum. In those infected with P. vivax and P. ovale, after stopping personal chemoprophylaxis, attacks of the disease may occur in periods characteristic of long-term manifestations (within 2 years, and sometimes later). In this regard, persons traveling from areas with a high risk of infection with these types of Plasmodium should be prescribed primaquine or quinocide.
Chemoprophylaxis of malaria during blood transfusion, i.e., prevention of infection of recipients as a result of blood transfusion or hemotherapy with the blood of donors who are possible carriers of malaria infection (for example, indigenous residents of endemic areas), is considered as a type of wedge, chemoprophylaxis. For this purpose, the recipient is prescribed any hematoschizotropic P. immediately after the administration of donor blood. (hingamine, amodiaquine, etc.) according to the treatment regimen for acute manifestations of malaria.
Interseasonal chemoprophylaxis is aimed at preventing long-term manifestations of three-day malaria with a short incubation and primary manifestations of three-day malaria with a long incubation in persons infected in the previous malaria season, who by the beginning of the next malaria season may turn out to be sources of infection. For this type of chemoprophylaxis, hisschisotropic P. s. (primaquine or quinocide), acting on long-existing extra-erythrocyte forms of the pathogen.
Most P. s. It is well tolerated and, when taken for a short time in therapeutic doses, usually does not cause serious side effects. The latter more often occur with prolonged use of P. s.
The nature of the side effects of P. with., belonging to different classes of chemicals. connections are different. Thus, hingamine and other 4-aminoquinoline derivatives can cause nausea and vomiting. With long-term continuous use (for many months), drugs in this group can cause visual impairment and vestibular disorders, hair depigmentation, liver damage and degenerative changes in the myocardium. With rapid intravenous administration of hingamine, collaptoid reactions may develop.
Diaminopyrimidine derivatives (chloridine, etc.) with short-term use sometimes cause headache, dizziness and dyspeptic disorders. The most severe manifestations of the side effects of these drugs with long-term use may be megaloblastic anemia, leukopenia and teratogenic effect, which are caused by the antifolic properties of P. s. this group.
Bigumal and other biguanides cause a transient increase in the number of neutrophils in the blood and leukemoid reactions in some patients. Long-term use of bigumal on an empty stomach is accompanied by loss of appetite, possibly due to inhibition of gastric secretion.
P.S. among the derivatives of 8-aminoquinoline (primaquine, quinocide) more often than other drugs cause side effects (dyspeptic disorders, chest pain, cyanosis, etc.). It should be borne in mind that the side effects of quinocide develop more often and are more severe when this drug is prescribed simultaneously with other drugs. The most severe manifestation of the side effect of 8-aminoquinoline derivatives may be intravascular hemolysis, which develops in individuals with congenital deficiency of the enzyme glucose-6-phosphate dehydrogenase in erythrocytes.
Quinine preparations are more toxic than other drugs. Side effects of quinine include tinnitus, dizziness, nausea, vomiting, insomnia, uterine bleeding. In case of overdose, quinine can cause decreased vision and hearing, severe headache and other disturbances from the c. n. pp., as well as collaptoid reactions. In case of idiosyncrasy to quinine, erythema, urticaria, exfoliative dermatitis, and scarlet-like rash occur. In persons with glucose-6-phosphate dehydrogenase deficiency, hemoglobinuric fever develops under the influence of quinine.
See also Malaria (treatment and chemoprophylaxis).
89. Antimalarial and antiamoebic drugs.
targets of action of antimalarial drugs.
a) erythrocyte schizonts
b) tissue schizonts:
1) pre-erythrocytic (primary tissue) forms
2) paraerythrocyte (secondary tissue) forms
c) sexual forms of plasmodia (gamonts)
drugs affecting erythrocyte schizonts.
Mefloquine, chloroquine (hingamine), quinine, pyrimethamine (chloridine), fansidar (pyrimethamine + sulfadoxine), little prime(pyrimethamine + yespson)
agents affecting pre-erythrocytic forms of malarial plasmodium.
Pyrimethamine, proguanil (bigumal)
agents affecting the sexual forms of malarial plasmodium.
a) gamontocidal: primaquine
b) gamontostatic: pyrimethamine
The principle of using antimalarial drugs for personal chemoprophylaxis.
Agents affecting pre-erythrocyte and erythrocyte forms of plasmodium.
Principle of using antimalarials to treat malaria
Agents affecting erythrocyte forms of plasmodium.
Spectrum of antimalarial action of mefloquine, chloroquine, quinine.
Mefloquine: hemantoshizontocidal action (Pl. falciparum, Pl. vivax)
Chloroquine: hemantoshizontocidal, gamontotropic action (Pl. vivax, Pl.ovale, Pl. malariae, but not Pl. falciparum)
Quinine: hemantoschizontocidal action (Pl. vivax, Pl.ovale, Pl. malariae, but not Pl. falciparum), gamontocidal (Pl. vivax, Pl.ovale, less on Pl. falciparum)
Spectrum of antimalarial action of pyrimethamine and proguanil.
Pyrimethamine and proguanil: histoschisotropic effect (Pl. falciparum)
Spectrum of antimalarial action of primaquine.
Primaquin: histotropic effect (P.vivax and P.ovale ) , hamontotropic effect (all types of plasmodia), hematotropic effect (Pl. vivax).
drugs for personal chemoprophylaxis.
Chloroquine, mefloquine; chloroquine + proguanil; chloroquine + primaquine; pyrimethamine; doxycycline
drugs for the treatment of malaria.
Chloroquine.
If: a) chloroquine resistant Pl. falciparum b) the pathogen is unknown or c) mixed malaria, the following are used: mefloquine, quinine, quinyl + doxycycline, pyrimethamine + sulfadoxine, pyrimethamine + dapsone.
drugs to prevent relapses of malaria (radical treatment).
Primaquine.
drugs for public chemoprophylaxis.
Primaquine.
agents that are effective for any localization of amoebas.
Metronidazole, tinidazole (Fasigin)
agents effective against intestinal localization of amoebas.
a) direct action, effective in localizing amoebas in the intestinal lumen – quiniophone, diloxanide, etofamide;
b) indirect action, effective in localizing amoebas in the intestinal lumen and wall – doxycycline
agents acting on tissue forms of amoebas.
a) effective in localizing amoebas in the intestinal wall and liver: emetine hydrochloride
b) effective in localizing amoebas in the liver: chloroquine.
Mechanism of action of quiniophone.
Antimicrobial and antiprotozoal action, has antiamoebic activity.
a) disrupts the oxidative phosphorylation systems of amoebas due to the halogenation of enzymes and the formation of chelate-like complexes with them
b) binds to Mg2+ and Fe, which are part of the structure of some amoeba enzymes and causes their inactivation
c) causes denaturation of pathogen proteins due to their halogenation
Pharmacokinetic properties of quiniophone, providing an amoebocidal effect.
It is absorbed from the gastrointestinal tract by only 10-15%, due to which high concentrations of the substance are created in the intestinal lumen, providing the amoebicidal effect of quiniophone.
Pharmacokinetic properties of diloxanide furoate.
Diloxanide furoate disintegrates in the intestine and is almost completely (90%) absorbed and excreted in the urine in the form of glucuronides. The remaining part of diloxanide furoate that does not enter the bloodstream is an active antiamoebic substance that is not affected by intestinal flora.
Side effects of quiniophone.
a) allergic reactions
b) diarrhea
c) optic neuritis
Side effects of emetine hydrochloride.
a) dyspeptic and dyspeptic disorders
b) cardiotoxicity: ECG changes, heart pain, tachycardia, arrhythmias, decreased cardiac output, hypotension.
c) skeletal muscles: pain, rigidity, weakness, possible formation of abscesses and necrosis
d) skin: eczematous, erythematous or urticarial rashes
e) nephrotoxicity
e) hepatotoxicity
Side effects of diloxanide furoate.
a) dyspeptic disorders: nausea, flatulence
b) allergic skin reactions: urticaria, itching
1. Drugs used for the prevention and treatment of malaria Hingamin Primaquine
Chloridine Quinine Sulfonamides and sulfones Mefloquine
2.Medicines used in the treatment of amoebiasis
Metronidazole Chingamine Emetine hydrochloride Tetracyclines Quiniophone
3. Drugs used in the treatment of giardiasis
Metronidazole Furazolidone Akrikhin
4. Drugs used in the treatment of trichomoniasis Metronidazole Tinidazole Trichomonacid Furazolidone
5. Drugs used in the treatment of toxoplasmosis Chloridine Sulfadimezine
6. Drugs used in the treatment of balantidiasis Tetracyclines Monomycin Quiniophone
7. Drugs used in the treatment of leishmaniasis Solyusurmin Sodium stibogluconate Metronidazole
Based on their chemical structure, antimalarial drugs are divided into the following groups.
Quinoline derivatives
4-substituted quinolines Chingamine (chloroquine) Quinine Mefloquine 8-aminoquinolines Primaquin
Pyrimidine derivatives Chloridine (pyrimethamine)
Antimalarials differ from each other in their tropism towards certain forms of Plasmodium development in the human body. In this regard, they distinguish:
1) hematoschizotropic drugs (affect erythrocyte schizonts);
2) histoschizotropic drugs (affect tissue schizonts);
a) affecting pre-erythrocytic (primary tissue) forms;
b) affecting paraerythrocyte (secondary tissue) forms;
3) gasontotropic agents (affect sexual forms). Knowledge of the direction of action of antimalarial drugs is of great importance for their effective use in treatment and prevention
For the treatment of amoebiasis.
Amoebicides effective in any locationpathological process Metronidazole
Direct-acting amoebicides, effective primarily when localizing amoebae in the intestinal lumen Hiniophone
Indirectly acting amoebicides, effective in localizing amoebae in the lumen and in the intestinal wall Tetracyclines
Tissue amoebicides acting on amoebae in the intestinal wall and liver Emetine hydrochloride
Tissue amoebicides, effective primarily when localized amoebae in the liver Chingamine See chemical structures.
Aminoquinol is a derivative of quinoline. Effective for giardiasis, toxoplasmosis, cutaneous leishmaniasis, as well as for some collagenoses. In most cases it is well tolerated. May cause dyspeptic disorders, headache, tinnitus, allergic reactions.
Metronidazole is a nitroimidazole derivative. It has a detrimental effect not only on Trichomonas, but also on amoebae and lamblia.
In addition to metronidazole, the group of nitroimidazoles also includes tinidazole. It is highly effective against trichomonas, amoebiasis and giardiasis. In addition, it has a bactericidal effect against a number of obligate anaerobes.
Nitazole and furazolidone are also effective for trichomonasosis.
For toxoplasmosis, chloridine, which inhibits the transition of dihydrofolic acid to tetrahydrofolic acid, should not be prescribed in the first half of pregnancy (it has a negative effect on the fetus). In this case, sulfonamides are used to prevent infection of the fetus.
Pentamidine is also used for toxoplasmosis.
Balantidiasis is treated mainly with monomycin, tetracyclines, and quiniophone.
In the treatment of visceral leishmaniasis, a pentavalent antimony drug, solyussurmin, is used.
Among the pentavalent antimony preparations, sodium stibogluconate is also used for leishmaniasis. The development of resistance of leishmania to antimonials should be taken into account.
Chloroquine, mefloquine, primaquine, pyrimethamine, quinine, metronidazole, tinidazole, quiniophone, doxycycline.
CHINGAMIN (Chingaminum). 4-(1-Methyl-4-diethylaminobutylamino)-7-chloroquinoline diphosphate.
Synonyms: Delagil, Rezoquine, Chloroquine, Aralen, Arechin, Artrichin, Atrochin, Avlochlor, Bemephate, Chlorochin, Chloroquine diphosphate, Chloroquini diphosphas, Delagil, Gontochin, Imagon, Iroquine, Klonokin, Malarex, Nivachine, Nivaquine, Quinachlor, Resochin, Roquine, Sanoquin, Tanakan, Tresochin, Trochin, etc.
Chingamine quickly causes the death of asexual erythrocyte forms of all types of plasmodium. It also has a gamontocidal effect. The drug is well and quickly absorbed and slowly released from the body.
Used for the treatment of acute manifestations of all types of malaria and chemoprophylaxis.
The spectrum of action of hingamin is not limited to the effect on malarial plasmodium. It has an inhibitory effect on the synthesis of nucleic acids, the activity of certain enzymes, and immunological processes. The drug is widely used in the treatment of collagenosis (diffuse connective tissue diseases): systemic lupus erythematosus, scleroderma and especially rheumatoid arthritis, for which it is considered as one of the basic drugs.
The drug has antiarrhythmic activity; in patients with extrasystole and paroxysmal atrial fibrillation, it helps restore sinus rhythm. By the nature of the action it belongs to group I antiarrhythmics.
When treating malaria, hingamine is prescribed orally (after meals).
Usually the drug is taken orally, but in case of malignant malaria, treatment begins with intramuscular administration.
It is administered intravenously only in particularly severe cases. Injected into a vein slowly.
After the patient’s condition improves, the injections are stopped and the drug is taken orally.
Children are given intramuscular injections only when absolutely necessary.
For prevention, hingamine is prescribed orally 2 times a week, during the malaria transmission season; children in accordance with age in doses in which the drug is prescribed on the 2nd and 3rd days of malaria treatment (see table).
When treating rheumatoid arthritis, give 0.25 g (1 tablet) 1 time per day after dinner, 2 to 3 hours before bedtime. The treatment is long-term. The therapeutic effect occurs after 3 - 6 weeks, and sometimes 3 - 6 months of taking the drug: pain gradually subsides, stiffness decreases, joint mobility improves, and exudative phenomena decrease. Along with the improvement of the clinical picture, ESR decreases, there is a tendency towards normalization of the protein composition of the blood, the content of C-reactive protein decreases, etc. The effect is more pronounced in diseases of mild and moderate severity with a predominance of exudative phenomena and to a lesser extent in severe cases with a predominance of proliferative ones phenomena. To accelerate and enhance the therapeutic effect, it is recommended to combine hingamine with glucocorticosteroids and non-steroidal anti-inflammatory drugs.
It is believed that the therapeutic effect of hingamine in rheumatoid arthritis is based on an immunosuppressive effect, a predominant effect on the metabolism of immunocompetent cells, as well as on the metabolism of connective tissue. Compared to other basic drugs (D-penicillamine, gold drugs, etc.), hingamine is considered less effective.
There is also evidence of the effectiveness of hingamine in ankylosing spondylitis (ankylosing spondylitis), Borovsky's disease, glomerulonephritis and amyloidosis of the kidneys, and lichen planus.
In lupus erythematosus, hingamine is more effective in subacute cases with a predominance of skin-articular syndrome. In acute cases of systemic lupus erythematosus, the drug is usually less effective; in these cases, hingamine should be used carefully in combination with hormonal therapy during the period of subsidence of acute manifestations of the disease.
For subacute lupus erythematosus, hingamine is prescribed in the first 10 days at 0.25 g 2 times a day (after lunch and dinner), and then at 0.25 g 1 time a day (after dinner); In total, 70 - 1OO tablets (17.5 - 25.0 g) are taken per course of treatment. In the acute course of systemic lupus erythematosus, hingamine is combined with hormonal drugs. In the spring, in order to reduce the phenomena of photosensitivity, hingamine can be prescribed prophylactically.
There is data on the treatment of discoid lupus erythematosus, keloid scars, and psoriasis with intradermal injections of a 5% solution of hingamin (delagil).
Local treatment with hingamine (delagil) in the form of electrophoresis in the joint area is used in patients with rheumatoid arthritis.
Chingamine (Delagil) is sometimes prescribed orally as an antiarrhythmic drug.
Short-term use of hingamine orally in therapeutic doses is usually tolerated without significant side effects. With long-term use, dermatitis may appear (often in the form of reddish-purple papules, reminiscent of lichen ruber and located on the extensor surface of the limbs and torso).
If dermatitis appears, the dose is reduced or the drug is discontinued. Dizziness, headache, nausea, sometimes vomiting, tinnitus, and disturbance of accommodation may occur. Usually these phenomena go away on their own.
There may also be a decrease in appetite, abdominal pain (due to irritation of the gastric mucosa); in some patients - temporary loss of body weight. Moderate leukopenia, decreased visual acuity, flickering in the eyes, and pigment deposition in the cornea are possible.
Large doses of hingamine can cause liver damage, dystrophic changes in the myocardium, graying of hair, and retinopathy.
When treating with hingamine, it is necessary to conduct general blood and urine tests, monitor liver function and periodically carry out ophthalmological examinations.
When prescribing hingamine in combination with other drugs (salicylates, corticosteroids, etc.), the possibility of increased skin damage (dermatitis) should be taken into account.
With slow parenteral administration of hingamine solutions, no complications are observed, but rapid intravenous administration can cause collapse.
Contraindications: severe heart disease, diffuse kidney damage, liver dysfunction, disease of the hematopoietic organs.
Presocyl. Combined tablets containing 0.04 g (40 mg) of chloroquine phosphate (Delagil), 0.75 mg of prednisolone and 0.2 g of acetylsalicylic acid.
Used for polyarthritis, rheumatic myositis, inflammatory diseases of the musculoskeletal system. Take 1 - 2 tablets 2 - 3 times a day.
For possible side effects and contraindications, see Khingamin, Prednisolone, Acetylsalicylic acid.
PRIMACHIN (Primachinum). 8-(4-Amino-1-methyl-butylamino)-6-methoxyquinoline.
Available in the form of diphosphate.
Synonyms: Avlon, Neo-Quipenyl, Primaquine diphosphate, Primaquini diphosphas.
It has an antiprotozoal effect on the sexual forms, schizonts and paraerythrocyte forms of all types of malaria plasmoids.
Used for the prevention of distant relapses in three- and four-day and tropical malaria. In addition, it is prescribed for personal chemoprophylaxis in combination with hingamine (chloroquine), as well as for public chemoprophylaxis.
Taken orally.
The drug is usually well tolerated, but abdominal pain, dyspeptic symptoms, and pain in the heart are possible; general weakness, cyanosis (methemoglobinemia). These phenomena disappear after discontinuation of the drug. Children should be prescribed the drug only with careful observation. In persons with deficiency of the enzyme glucose-6-phosphate dehydrogenase in red blood cells, acute intravascular hemolysis with hemoglobinuria may occur (see Quinocid). In severe cases, the picture resembles hemoglobinuric fever.
When prescribing primaquine to patients with symptoms of anemia and if a red blood cell abnormality is suspected, great care must be taken and blood and urine should be examined regularly; at the first signs of a change in the color of urine, a sharp decrease in the hemoglobin content or the number of leukocytes, the drug is immediately discontinued.
Among the population of some areas of the Mediterranean, Transcaucasia and Africa (especially often), there are persons with congenital deficiency of glucose-6-phosphate dehydrogenase, therefore, in these areas, primaquine should be prescribed with extreme caution, not exceeding a daily dose of 0.015 g based on the base (0. 027 g diphosphate) for an adult; During treatment, careful monitoring of the patient is necessary.
You should not take primaquine simultaneously with quinine (primaquine lingers in the blood, and therefore its toxicity increases) and in the immediate future after taking quinine (due to the slow release of quinine from the body), as well as together with drugs that can have a hemolytic effect and inhibit myeloid elements bone marrow (sulfonamides, etc.).
Primaquine is contraindicated in persons with acute infectious diseases (except malaria), during exacerbation of rheumatism and other diseases characterized by a tendency to granulocytopenia, in diseases of the blood and hematopoietic organs, kidney diseases, angina pectoris. Primaquine should not be used simultaneously with drugs that inhibit hematopoiesis.
CHLORIDINE (Chloridinum). 2, 4-Diamino-5-para-chlorophenyl-6-ethyl-pyrimidine. Synonyms: Daraprim, Pyrimethamine, Tindurine, Daraclor, Darapran, Daraprim, Malocide, Pyrimethamine, Tindurin.
The drug has an antiprotozoal effect and is effective against Plasmodium malaria, Toxoplasma and Leishmania.
In leishmaniasis, chloridine damages promastigotes (flagellar stages of Leishmania), which leads to disruption of the development of leishmaniasis in the mosquito's body.
Chlorilin is well absorbed and circulates in the blood for a long time (within 1 week after a single dose); excreted mainly by the kidneys.
Chloridine is taken orally simultaneously with sulfonamides and/or hingamine, and the effectiveness of chloridine is significantly increased.
Children are given in smaller doses according to age.
For acute forms of malaria, take the drug for 2 - 4 days. For the prevention of malaria and leishmaniasis, it is prescribed 3-5 days before the onset of danger of infection and continues to be given once a week throughout the entire period of possible infection and for another 4-6 weeks.
For acute and chronic toxoplasmosis, take chloridine in cycles of 5 days with a break between them of 7 - 10 days. The course of treatment is 2 - 3 cycles. If necessary, courses (3 in total) are repeated with an interval of 1 - 2 months.
To prevent congenital toxoplasmosis, chloridine is prescribed to women with acute and subacute toxoplasmosis, starting from the 16th week of pregnancy, but not earlier than the second trimester. The course of treatment is 2 cycles with an interval of 10 days. Depending on the stage of pregnancy, up to 3 courses are carried out with a break between them of 1 month.
In earlier stages of pregnancy, chloridine should not be given (to avoid toxic effects on the fetus), and in later stages it should also be given with caution.
Sulfanilamide drugs (see Sulfapyridazine, Sulfadimethoxine, Sulfalene) are prescribed simultaneously with chloridine.
When taking chloridine, side effects may occur: headache, dizziness, pain in the heart, dyspepsia, stomatitis, retinopathy, alopecia.
Due to the fact that chloridine is an antagonist of folic acid, its long-term use can cause side effects associated with impaired absorption and metabolism of this vitamin. Such manifestations include megaloblastic anemia, less commonly leukopenia, as well as teratogenic effects,
Contraindications: diseases of the hematopoietic organs and kidneys. During treatment with chloridine, blood and urine tests are done.
Chloridine should not be prescribed to women in the first trimester of pregnancy and to children in the first 2 months of life.
QUININE (Chininum).
Quinine has a wide range of effects on the human body. It inhibits thermoregulatory centers and reduces body temperature during febrile illnesses; reduces the excitability of the heart muscle, lengthens the refractory period and somewhat reduces its contractility; stimulates the muscles of the uterus and enhances its contractions, contracts the spleen.
Quinine is a CNS depressant; in large doses causes a state of stunning, ringing in the ears, headache, dizziness; may cause visual impairment.
In medical practice, the following quinine salts are used.
Quinine hydrochloride (Chinini hydrochloridum; synonyms: Chininum hydrochloricum, Quinini hydrochloridum).
Colorless shiny needles or white finely crystalline powder, very bitter in taste. Soluble in water (easier in hot water).
Quinine dihydrochloride (Chinini dihydrochloridum).
Colorless crystals or white crystalline powder. Very bitter taste. Very easily soluble in water.
Quinine sulfate (Chinini sulfas, synonyms: Chininum sulfuricum, Quinini sulfas).
Colorless, shiny, silky, needle-shaped crystals or white, finely crystalline powder, bitter in taste. Slightly soluble in water.
Quinine hydrochloride and sulfate are prescribed in tablets, powders, capsules; dihydrochloride - in the form of injections.
For malaria, adults take quinine sulfate or hydrochloride orally.
For malignant malaria, quinine dihydrochloride is injected deep into the subcutaneous fatty tissue (but not into the muscles). In extremely severe cases, the first injection is given intravenously. It is administered intravenously very slowly. The solution is preheated to + 35 C. Following injection into a vein, 0.5 g (1 ml of a 50% solution) of quinine dihydrochloride is injected into the subcutaneous fatty tissue. The remaining amount of quinine (1 g) is administered subcutaneously after 6 - 8 hours.
Before intravenous administration, it is necessary to make sure that the patient previously tolerated quinine well. In the presence of idiosyncrasy to quinine, intravenous administration can cause sudden death.
In cases of vascular weakness (frequent small pulse, sunken veins), an isotonic sodium chloride solution and tonics are simultaneously injected under the skin: camphor, caffeine, ephedrine, norepinephrine, corazol, etc.
On subsequent days of the cycle, treatment is carried out with quinine injections, also at a dose of 2 g per day. Upon return of consciousness and in the absence of diarrhea, quinine is prescribed orally.
Quinine often causes side effects: tinnitus, dizziness, vomiting, palpitations, hand tremors, insomnia. With idiosyncrasy to quinine, even small doses can cause erythema, urticaria, increased body temperature, uterine bleeding, and hemoglobinuric fever.
Contraindications: hypersensitivity to the drug, indications of deficiency of the enzyme glucose-6-phosphate dehydrogenase, hemoglobinuric fever, diseases of the middle and inner ear. Relative contraindications: cardiac decompensation and late months of pregnancy. When prescribing quinine to pregnant women to avoid miscarriage, the daily dose should not exceed 1 g, and this dose should be divided into 4 - 5 doses.
To induce and enhance labor, quinine salts (usually hydrochloride) were previously prescribed usually in combination with other labor stimulants (estrogens, oxytocin, calcium chloride, etc.). For uterine hypotension in the early postpartum period, 1-3 ml of a 50% solution of quinine dihydrochloride in 20 ml of a 5% glucose solution or isotonic sodium chloride solution is sometimes administered intravenously.
Currently, due to the emergence of new effective drugs (see Drugs that stimulate the muscles of the uterus), quinine is not used in obstetric practice.
Due to its ability to reduce the excitability of the heart muscle and lengthen the refractory period, quinine was previously used to treat and prevent extrasystoles, usually in combination with digitalis preparations. To prevent attacks of paroxysmal tachycardia, 0.1 g of quinine hydrochloride was prescribed orally for a long time (7-10 days per month) 2-3 times a day. During attacks of paroxysmal tachycardia, they sometimes resorted to intravenous administration of a solution of quinine dihydrochloride: 1 - 2 ml of a 50% solution or 2 - 4 ml of a 25% solution were injected slowly.
Currently, the quinine isomer quinidine sulfate (see) is relatively widely used as an antiarrhythmic drug.
Tinidazole. 1-(2-Ethylsulfonylethyl)-2-methyl-5-nitroimidazole.
Synonyms: Tinib, Tridazole, Fasigyn, Ametin, Fasigyn, Glongyn, Pletil, Tiniba, Tinidex, Tinogin, Tores, Tricanix, Tricolam, Triconidazol, Tridazol, Trinigyn, etc.
Its structure and action are similar to metronidazole. Used for trichomoniasis in women and men, as well as for giardiasis and amoebic dysentery.
To treat trichomoniasis, men and women take tinidazole tablets orally.
For giardiasis, it is prescribed in a dose of 2 g (4 tablets) once 40 - 50 minutes after breakfast or 0.3 g per day for 7 days, and in case of persistent disease, 6 - 7 courses are carried out; for amoebic dysentery - 1.5 g (3 tablets) 1 time per day for 3 days.
Contraindications are the same as for metronidazole.
CHINIOFON (Chiniofonum).
A mixture of 7-iodo-8-hydroxy-5-quinoline sulfonic acid with sodium bicarbonate (3: 1).
Synonyms: Yatren, Amoebosan, Anayodin, Avlochin, Chinosulfan, Iochinolum, Loretin, Myxiodine, Quiniofonum, Quinoxyl, Rexiode, Tryen, Yatrenum, etc.
For parenteral administration, the drug is dissolved aseptically in freshly boiled and cooled to + 80 C sterile water for injection.
The drug is not widely used at present. Sometimes it is prescribed orally and parenterally for amoebic dysentery and ulcerative colitis, externally - in the form of solutions (0.5 - 3%), ointments (5 - 10%) and powders (10%) for the treatment of purulent wounds, ulcers, burns, and also in gynecological and urological practice.
For amoebic dysentery, quiniophone is given to adults at 0.5 g 3 times a day. The course of treatment is 8 - 10 days (or 2 cycles of 5 days with a break of 5 days). The course of treatment can be repeated after a 10-day break.
Quiniophone can also be used in the form of enemas.
In acute cases of intestinal infection, quiniophone can sometimes be used together with emetine.
Personal prevention. When visiting malarial areas, you should try to avoid mosquito bites, especially during periods of active blood-sucking (usually early morning or evening), screen your home, use bed curtains, use repellents and pyrethrum insecticide sprays, and wear appropriate clothing. Along with this, chemoprophylaxis should be carried out, as described below.
Chemoprophylaxis (Table 154-2). Although it is impossible to prevent malaria infection with chemotherapy drugs, the use of appropriate drugs can suppress the clinical manifestations of the disease while a person lives in endemic areas. Due to its effectiveness and safety, chloroquine remains the drug of choice for people traveling to areas where the disease is spreading. Cases of retinopathy have been described in individuals taking this drug in prophylactic doses for more than 5-20 years. However, this complication is quite rare, and for persons planning a short stay in endemic areas, this danger can be neglected. It is recommended to start taking chloroquine 1-2 weeks before departure to endemic areas. This allows you to check for early side effects and ensure the creation of a therapeutic concentration of the drug in the blood. If this cannot be done, the prophylactic dose of the drug should be doubled in the first weeks of stay in the endemic area. But due to the fact that protection is not complete, malaria should always be kept in mind in the differential diagnosis of any febrile illness that occurs during a stay in a given area. After leaving the endemic area, chloroquine should be taken for an additional 6 weeks. This will eliminate infection caused by P. malariae and sensitive strains of P. falciparum. However, chloroquine is ineffective against the hepatic forms of P. ovale and P. vivax, and the latter can cause relapses of clinical manifestations of the disease weeks or months after stopping the drugs. Relapses can be prevented if chloroquine is used in combination with primaquine for the last 2 weeks.
Chloroquine is not effective for treating patients with chloroquine-resistant falciparum (CRFM). Nevertheless, it is indicated for persons traveling to areas where XUTM is distributed, since other forms of malaria, the pathogens of which are sensitive to this drug, are also common in these places. To suppress chloroquine-resistant falciparum, the combined use of chloroquine and Fansidar tablets, a combination of 25 mg chloridine and 500 mg sulfadoxine, can be used. Fansidar is contraindicated in pregnant women, persons with hypersensitivity to sulfonamide drugs and children under 2 months. With long-term use of chloridine, the development of leukopenia and megaloblastic anemia is possible. Several cases of severe skin reactions (erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis) have been reported among American tourists taking chloridine and sulfadoxine prophylactically. Given the possibility of adverse reactions when taking Fansidar prophylactically, it should be recommended only to persons traveling to areas of intense transmission of chloroquine-resistant falciparum. These areas include countries in Africa, Oceania (Papua, New Guinea, Solomon Islands and Vanuatu) and certain rural areas of China, Southeast Asia and South America. If the duration of the trip to these areas does not exceed 3 weeks, the traveler is recommended to have a therapeutic dose of Fansidar in his personal first aid kit for the preliminary treatment of any febrile illness that arises during the trip if it is not possible to quickly seek qualified medical help. The above-mentioned severe skin reactions observed during prophylactic administration of Fansidar were not observed in the case of a single dose of the drug for therapeutic purposes.
Table 154-2. Chemoprophylaxis of malaria
| Preparation | ||
| Suppressing clinical malaria in areas without chloroquine-resistant strains | Chloroquine phosphate | 500 mg (300 mg base) orally once a week, then for 6 weeks after leaving an endemic area 520 mg (400 mg base) orally once a week, then for 6 weeks after leaving an endemic area |
| Suppression of clinical manifestations of malaria in areas where there are chloroquine-resistant strains | Same as above, plus chloridine sulfadoxine (fansidar, Hoffman-La Roche) or mofloquine | 25 mg inine chloride and 500 mg sulfadoxine orally once a week, then for 6 weeks after leaving the endemic area 250 mg orally once a week, then for 6 weeks after leaving the endemic area |
| Prevention of relapses of tertian malaria and malaria ovale | Primaquine phosphate 2 | 26.3 mg (15 mg base) orally daily for 14 days or 79 mg (45 mg base) for 8 weeks; prescribed during the last 2 weeks of suppressive therapy or immediately after its completion |
Prescribe only in areas of intense malaria transmission, as indicated in the text.
Of the available drugs, the most promising alternative to Fansidar for the prevention of chloroquine-resistant falciparum is mefloquine, a methanolquinoline compound mentioned above in the Treatment section. Being safe and effective, mefloquine has found widespread use in Southeast Asia, where cases of Fancidar-resistant falciparum malaria are common. It is not yet approved for use in the United States, and availability is still limited elsewhere in the world. Amodiaquine, a 4-aminoquinoline compound related to chloroquine, may provide slightly greater protection than chloroquine against African strains of chloroquine-resistant falciparum. This drug is not commercially available in the United States, but is widely available in Africa.
Blood transfusion. Cases of transfusion malaria, usually caused by P. malariae and P. falciparum, continue to be reported in the United States. Following the recommendations of the American Association of Blood Banks will prevent most of these cases.
PREVENTION OF CAMALARIA
(memo for those traveling to tropical countries)
Malaria is an infectious disease that is transmitted from a sick person to a healthy person through the bites of malaria mosquitoes. It is widespread in countries with tropical climates. The disease is severe, with general malaise, attacks, high fevers, chills, disorders of the digestive, nervous and other body systems. In the case of a severe malignant course of the disease, it can result in a serious outcome.
MALARIA IS PREVENTABLE.
REMEDIES - TAKEN ANTI-MALARIAL DRUGS
AND PROTECTION AGAINST MOSQUITO BITES!
CHEMIOPREVENTION.
The use of delagil (chlorohil) and a combination of sulfonamides with pyrimethamine (fansidar, metakelfin) for prophylactic purposes is not recommended due to their low effectiveness.
Currently, for short trips (up to those months) for the vast majority of endemic countries, the chemoprophylactic drug is mefloquine (Lariam), which is prescribed at a dose of 250 mg base for an adult once a week plus 4 weeks after return (once a week).
For a limited number of endemic countries in Asia and North America, where the pathogen is polyresistant, a combination of chloroquine with proguanil is recommended for chemoprophylaxis: 300 mg of chloroquine base once a week and 200 mg of proguanil daily plus 4 weeks after return (taken once a week).
After arriving in the host country, it is advisable to consult with the embassy doctor about the need for chemoprophylaxis of malaria in a particular place of stay, the timing of its implementation, as well as about antimalarial drugs that can be purchased at the local pharmacy network, their regimens and doses. In some cases, malaria can occur even when taking antimalarial drugs. Therefore, in case of ailments accompanied by an increase in temperature, you should immediately consult a doctor.
Malaria mosquitoes attack humans more often in the evening and at night. At this time, it is advisable to wear clothing that covers most of the body; exposed parts of the body are lubricated with repellents. To prevent mosquitoes from entering the premises, windows and doors must be screened. If flying mosquitoes are detected, they are destroyed mechanically or using insecticide aerosols.
When returning to the USSR, you must inform your local doctor about your arrival from tropical countries. Taking the drug should be continued for 4 weeks after leaving the malarial area, since during this period, in the absence of chemoprophylaxis, there is the greatest likelihood of manifestations, especially the danger of a malignant form of tropical malaria.
It must be remembered that other forms of malaria can be contracted at a later date, even with chemoprophylaxis. Therefore, in case of any illness within 2 years after returning from the tropics, do not forget to remind your doctor that you were in the tropics.
Remember that the more accurately you follow the rules for preventing malaria, the less likely you are to get this disease.
Drugs used for chemoprophylaxis
tropical malaria
|
Drugs or their combination |
DOSES |
SCHEMES |
|||||
|
For adults |
For children |
Before leaving for the risk zone |
After returning |
||||
|
9-12 |
13-14 |
||||||
|
Delagil (chlorogil) |
mg/week |
In 1 week 1 time per week |
4 weeks 1 time per week |
||||
|
Delagig (chloroquine) + proguanil |
300 mg/week 200 mg/week |
1 dose adult |
|||||
|
Mefloquine |
250 mg/week |
1 week once |
4 weeks 1 time per week |
||||
|
Doxycycline |
100 mg/week |
1 dose adult |
|||||
1) In total, the period of use should not exceed 4-6 months; the drugs are contraindicated in children under 1 year of age. For pregnant women: chloroquine + proguanyl only in the first 3 months, mefloquine from 4 months. Pregnancy is desirable only 3 months after completion of mefloquine prophylaxis and 1 week after doxycycline.
2) The drug is calculated based on the basis.
3)Children of younger age groups are prescribed chloraquine in syrup at the rate of 5 mg/kg body weight.
4) In order for the required concentration in the blood to be achieved by the time the risk of infection occurs and the possible intolerance.
The spread of malaria in countries around the world
and its chemoprophylaxis.
|
Continent, country, region |
Scheme chemoprofile. |
Malaria transmission period and zones within the country |
|
Afghanistan |
D + P |
From May to November, in zones below 2000 meters, tropical malaria occurs in the south of the country in certain regions. |
|
Bangladesh |
Mefloquine |
All year round, everywhere except Dhaka, in forests and areas along the south-eastern border. |
|
Butane |
D + P |
All year round in 5 provinces bordering India: Shirang, Gaylegput, Samchi, Samdrupionghar and Shemgang. |
|
Vanuatu |
Mefloquine |
All year round, except O. Futuna |
|
Vietnam |
Mefloquine |
All year round, everywhere, except for the central industrial areas and the Red River Delta, there is high resistance to delagil and fansidir. |
|
India |
D + P |
Throughout the year, everywhere, except in a number of districts of Himakal, Pradesh, Jammu and Kashmir, Sikkim, there is high resistance to dalagil in some states. |
|
Indonesia |
D + P Mefloquine |
All year, everywhere, except for large cities and Jakarta, tourist centers on the islands of Java and Bali. In Irian Jaya. |
|
Iran |
From May to October, mainly in the north below 1500 m (provinces of Duhok, Erbil, Tamim, Nineveh, Sulaymaniyah, Basra). |
|
|
Yemen |
D+ P |
All year round, everywhere from September to February except Aden and the airport area. |
|
Cambodia |
Mefloquine Doxycycle. |
All year round, including the tourist center of Angkorwat, except Phnom Penh. In the western provinces |
|
China |
Mefloquine |
North of 33 N latitude. from July to November, between 33 and 25 N latitude. from May to December, south of 25 N latitude. all year only in rural areas below 1500 m. No transmission: Heilongjang, Zhilin, Nei, Mongol, Gansu, Beijing, Shanghai, Qinghai, Xinjiang. In tropical malaria areas of Hainan and Yunnan. |
|
Laos |
Mefloquine |
All year, everywhere except Vietnam. |
|
Malaysia |
D + P Mefloquine |
Only in limited pockets inland and in Sarawak, urban and coastal areas are free of malaria. In Sabah throughout the year. |
|
Myanmar |
Mefloquine |
All year -Karen, from March to December Chin, Kachin, Mon, Rahin, Shan, Pegu, Kayah, from April to December in rural areas of Tenase-rim, from May to December in Irwyvdi and in rural areas of Mandalay, from June to November Magwe Sagaing. |
|
Nepal |
D + P |
All year round in rural areas of Treai district and along the Indian border. |
|
UAE |
D + P |
In the valleys of the mountainous northern regions. No risk in Abu Dhabi, Dubai, Sharjah, Ajman and Umal Khayoum. |
|
Oman |
D + P |
|
|
Pakistan |
D + P |
Throughout the year below 2000 m everywhere. |
|
Papua New Guinea |
Mefloquine |
All year round everywhere below 1800 m. Resistant to chloroquine. |
|
Saudi Arabia |
D + P |
All year in the western and southern provinces, no risk in Jeddah, Medina, Mecca, Taif. |
|
Solomon Islands |
Mefloquine |
All year round, except for islands to the South and Southeast. |
|
1 |
2 |
3 |
|
Syria |
From May to October in several outbreaks in the northeast of the country. |
|
|
Thailand |
Mefloquine Doxcycle. |
All year round, everywhere in rural forested areas, except Bangkok, Pattaya, Phuket, Chiang Mai. In areas bordering Cambodia and Myanmar, resistant to quinine and mefloquine. |
|
Hong Kong |
Chloroquine |
Slight risk in some rural areas. |
|
Türkiye |
Chloroquine |
Shukurova/Amikova Southeast Anatolia, March to November |
|
Azerbaijan |
Chloroquine |
Southern regions, as well as the Khochmaz zone, from April to November |
|
Tajikistan |
Chloroquine |
Southern regions bordering Afghanistan, from June to October |
|
Turkmenistan |
Chloroquine |
From June to October, areas bordering Afghanistan. |
|
Philippines |
D + P |
All year round everywhere in areas below 600 m. No risk in the provinces of Bohol, Catanduan, Cebu and all peas. |
|
Sri Lanka |
D + P |
All year round, except for the districts of Colombo, Kalutara, Nuwara Eliya. |
|
AFRICA |
||
|
Algeria |
The risk is limited to an outbreak in Ihrir (Illizi department). |
|
|
Angola |
Mefloquine |
|
|
Benin |
Mefloquine |
All year round, more than 85% tropical malaria |
|
Botswana |
D + P |
From November to May-June in the northern zones of Boteti, Chobe, Ngamiland, Okavango, Tutume. |
|
Burkina Faso |
Mefloquine |
All year round |
|
Gabon |
Mefloquine |
All year round |
|
Gambia |
Mefloquine |
All year round |
|
Ghana |
Mefloquine |
All year round |
|
Guinea |
Mefloquine |
All year round |
|
1 |
2 |
3 |
|
Guinea-Bissau |
Mefloquine |
All year round |
|
Djibouti |
Mefloquine |
All year round |
|
Egypt |
From November to October in El Fayoum. |
|
|
Zaire |
Mefloquine |
All year round |
|
Zambia |
Mefloquine |
All year round |
|
Zimbabwe |
Mefloquine |
All year round in the Zambezi River valley from November to June in areas below 1200 m in Harare and Bulawayo the risk of infection is low. |
|
Cameroon |
Mefloquine |
All year round |
|
Capo Verde |
Not recommended. |
From September to November, only Santiago |
|
Kenya |
Mefloquine |
All year round, with the exception of a limited risk in Nairobi (except for the outskirts) at an altitude of more than 2500 meters in the provinces of Central, Rift Valley, Eastern, Western, Nyaza |
|
Comoros |
Mefloquine |
All year round |
|
Ivory Coast |
Mefloquine |
All year round |
|
Congo |
Mefloquine |
All year round |
|
Liberia |
Mefloquine |
All year round |
|
Mauritius |
All year in some rural areas except Rodriguez Island. |
|
|
Mauritania |
D + P |
All year round, except in the northern zones. In Adrar and Inshiri, the risk is only during the summer season (July-October). |
|
Mayotte |
Mefloquine |
All year round |
|
Madagascar |
Mefloquine |
All year round, especially in coastal areas. |
|
Malawi |
Mefloquine |
All year round |
|
Mali |
Mefloquine |
All year round |
|
Morocco |
From May to October in selected rural areas: Khemisset, Beni Mellal, Khenifra, Taza, Larash, Khuribda, Settat, Sheroen. |
|
|
Mozambique |
D + P |
From November to May-June in the northern regions, all year in the Kavango Valley. |
|
Niger |
Mefloquine |
All year round |
|
Nigeria |
Mefloquine |
All year round |
|
1 |
2 |
3 |
|
Rwanda |
Mefloquine |
All year round |
|
Sao Tome and Principe |
Mefloquine |
All year round |
|
Swaziland |
Mefloquine |
All year round |
|
Senegal |
Mefloquine |
All year round |
|
Somalia |
D + P |
Weight year everywhere |
|
Sudan |
Mefloquine |
All year round |
|
Sierra Leone |
Mefloquine |
All year round |
|
Tanzania |
Mefloquine |
All year round, below 1800 m |
|
Togo |
Mefloquine |
All year round |
|
Uganda |
Mefloquine |
All year round |
|
CAR |
Mefloquine |
All year round |
|
Chad |
Mefloquine |
All year round |
|
Equivalent Guinea |
Mefloquine |
All year round |
|
Eritrea |
Mefloquine |
All year round, except Asmara. |
|
Ethiopia |
Mefloquine |
All year round, below 2000 m except Addis Ababa |
|
South Africa |
D + P |
All year round in high altitude zones, including nature reserves in the north and east of the Transvaal, northeast of Natal to the river. Tugela. |
|
CENTRAL AND SOUTH AMERICA |
||
|
Argentina |
From October to May in rural areas below 1200 m in the provinces bordering Bolivia and Paraguay. |
|
|
Belize |
All year round, except in urban areas. |
|
|
Bolivia |
Mefloquine |
All year round, everywhere in rural areas below 2500 m, except in the department of Oruro, the provinces of Ingavi, Andes, Omasuyos, Pacayes, as well as in the south and center of the department of Potosi. Tropical malaria exists in the north in the departments of Beni and Pondo, areas bordering Brazil. |
|
1 |
2 |
3 |
|
Brazil |
Mefloquine |
All year below 900 m, in rural areas of the Amazon basin. high risk in mining and agricultural areas. |
|
Venezuela |
Mefloquine |
All year round in rural areas, especially Sucre, Bolivar, Amazonas, Apure, Barinas, Delta Amacuro, Merida, Monagas, Portuguesa, Tachira, Zulia. |
|
Haiti |
All year, everywhere below 300 m in rural areas and outskirts of cities. |
|
|
Guyana |
Mefloquine |
All year round, in the interior of the country, including the north-west and areas along the river. Pomeranian. |
|
Guatelmala |
All year, below 1500 m in the departments of Alta Verapaz, Baya Verapaz, Chimaltenango, Huehuete nengo, Izabal, Peten, Quiché, San Marcos, Zacapa, Jutiapa. |
|
|
Guiana Fr |
Mefloquine |
All year round, in the interior of the country. |
|
Honduras |
All year round in the departments of Atlantis, Choluteca, Colon, El Paraiso, Gracias a Dios, Vale, Yoro, mainly in rural areas. |
|
|
Dominican Republic |
All year round, only tropical malaria is widespread in rural areas of the provinces: Barahona, Dajabón, Elias Pina, Independencia, Montecristi, Pedernales, Bannica, El Lano, Partido. |
|
|
Colombia |
Mefloquine |
All year, everywhere in rural areas below 800 m in the departments of Antioch, Cordoba, Norte de Santander, Choco all Pacific coasts, eastern plains of Orinoco and Amazonia |
|
1 |
2 |
3 |
|
Costo Rica |
All year, everywhere in rural areas below 700 m in the province of Geridia, the cantons of Matina, Los Chiles and Talamanca, Central de Limona. |
|
|
Mexico |
All year round, throughout certain rural areas: Oaxaca, Chiapas, Guerrero, Campeche, Quintana Ru, Sinaloa, Michoacan, Colima, Tabasco, Hidalgo. |
|
|
Nicaragua |
From June to December in rural areas in the suburbs of Bluefields, Bonanza, Chinandega, Leon, Matagalpa, Jinotega, Puerto Cabeza, Rosita, Siuna. |
|
|
Panama |
All year round in rural areas of lakes Gatun, Baiana, Alto Chacunac, Darien, in the continental zone of San Blas. |
|
|
Paraguay |
From October to the end of May in selected rural areas bordering Brazil, the departments of Albo Parana, Amambay, Caaguaza, Canendiu and San Pedro. |
|
|
Mefloquine |
All year round, everywhere in rural areas below 1500 m (Andean valley and the shores of the Amazon basin). In the border areas with Brazil, Bolivia, Colombia, Ecuador. |
|
|
Mefloquine |
All year round, except for the Paramaribo district and coastal areas north of 5 degrees north latitude. |
|
|
Mefloquine |
All year, below 1500 m in the provinces of El Oro, Esmeraldas, Guayas, Los Rios, Manabi, Morano, Santiago, Napo Pastaza, Pichincha, Sucumbios, Zamora Chinchipe |
|
|
El Salvador |
All year round. Higher risk below 600 m during the rainy season. |
D-delagil (chloroquine), D + P - delagig + proguanil, Mefloquine - (lyriam).
Doksits. - doxycycline.
Definition:
Malaria is a protozoal anthroponotic disease with predominantly transmissible transmission of pathogens through the bite of an Anopheles mosquito, characterized by febrile paroxysms, anemia, enlarged spleen and liver, and a tendency to relapse.
Clinical classification:
I. By etiology:
- Three-day
- Four-day
- Tropical
- Ovale - malaria
- Mixed forms.
II. According to the severity of clinical manifestations:
III. By severity: light, medium, heavy.
IV. According to the presence and absence of complications in tropical malaria:
- Complicated (malarial coma - cerebral, algid malaria, hemoglobinuric fever, acute renal failure, etc.).
- Uncomplicated.
V. According to sensitivity to antimalarial drugs:
- Resistant
- Non-resistant.
VI.According to the occurrence of the disease:
- Primary manifestations.
- Relapses.
VII. In combination with other diseases:
Criteria for diagnosis.
Epidemiological history:
- indication of stay in endemic foci of malaria, in countries with hot climates during the last three years before the disease;
- indication of malaria in the past (relapse);
- blood transfusions within three months or less before the onset of the disease.
Clinical manifestations:
The disease is characterized by an acute onset with the sudden onset of chills and a rapid increase in body temperature to 39-40°C, followed by a feeling of heat followed by profuse sweating. An attack of fever ends with a critical decrease in body temperature to normal values. During the period of apyrexia, the state of health of patients can be satisfactory.
Objective data:
During an attack:
- facial hyperemia; scleral vascular injection, dry hot skin.
After two or three attacks it is discovered:
- pale skin or jaundice;
- hepatosplenomegaly.
Features of the course of various forms of malaria.
Tropical malaria:
- incubation period - 7-10 days;
- onset of the disease with a prodromal period for 1-2 days:
- often the first symptom is diarrhea;
- fever is constant or remitting, periods of apyrexia
- not expressed (t° does not decrease to normal);
- characterized by irregularity and prolongation of paroxysms (days);
- the spleen enlarges by the 10th day of illness and reaches a large size;
- possible kidney damage;
- There are no late relapses, complications are frequent (malarial coma, acute renal failure, pulmonary edema).
- hemoglobinuric fever, algid, hypoglycemia, acute hemolysis;
- mortality with late diagnosis and inadequate therapy is high.
Malaria in young children:
- malarial paroxysms are not expressed;
- frequent bouts of vomiting:
- frequent stools without pathological impurities;
- convulsions even at moderately elevated temperatures;
- slow enlargement of the liver and spleen (earlier in three-day than in tropical);
- anemia develops quickly;
- Children from 6 months to 4-5 years are most seriously ill.
Malaria in pregnant women:
- danger of severe course;
- severe anemia, especially with tropical malaria;
- sharp enlargement of the spleen and liver;
- the risk of abortion, premature birth, postpartum complications and death.
It occurs in endemic areas after repeated clinically severe forms of the disease.
Laboratory criteria.
Detection of malarial plasmodia by microscopic examination of blood products (thin smear, thick drop), or confirmed by molecular diagnostics using polymerase chain reaction.
Laboratory and instrumental research methods. At level 1:
- general blood test (decrease in the number of red blood cells, hemoglobin concentration, aniso- and poikilocytosis, increase in reticulocyte content, tendency to thrombocytopenia, leukopenia with relative lymphocytosis, monocytosis, increase in ESR).
At level 2-3:
- examination of blood products - thick drops and a thin smear (at least 100 fields of view in a thick drop);
- general blood test;
- general urinalysis.
According to indications: urea, creatinine; electrolytes (potassium); blood sugar test; bilirubin and its fractions; hemostasigram. Instrumental: ultrasound of the liver, spleen.
Case classification
The standard definition is a case of protozoal anthroponotic disease, manifested by febrile paroxysms, anemia, enlargement of the spleen and liver, or asymptomatic carriage, with the presence of malarial plasmodia in a blood product.
- A suspicious case is a patient with febrile paroxysm, hepatosplenomegaly and anemia in the clinic.
- Confirmed case:
A patient who has febrile paroxysm, hepatosplenomegaly, anemia and laboratory confirmation of the presence of plasmodium in blood products (smear and thick drop) in the clinic.
In the absence of symptoms, but laboratory testing - detection of plasmodium in blood products (smear and thick drop).
A medical worker who identifies a patient with malaria or suspected of it submits an emergency notification (f. 58/u). Only laboratory confirmed cases are subject to registration in the accounting system.
Indications for hospitalization
Treatment of malaria
Treatment is prescribed immediately after a laboratory diagnosis is established.
If the laboratory result is delayed (more than 3-6 hours), a patient suspected of malaria can begin preliminary treatment, but with the condition of a full therapeutic dose. In this case, in the absence of a positive laboratory result, the course of treatment is stopped.
Treatment of three-day malaria
Cupping Treatment of patients with three-day malaria is carried out with a hematoschizotropic drug - chloroquine diphosphate(delagil) (1 tablet contains 150 mg or 300 mg of base) according to the standard regimen.
The course of treatment for adults consists of taking 25 mg of the drug base per 1 kg of body weight for three days:
Day 1 - 10 mg/kg in two doses every 6-8 hours;
Day 2 - 10 mg/kg in two doses every 6-8 hours;
Day 3 - 5 mg/kg in one dose.
(total 10+10+5=25 mg.).
Doses of chloroquine (Delagil) for the treatment of malaria in children
|
Doses of chloroquine in tablets of 150 mg. |
||||||||
|
Age |
0-3 months |
4-11 months |
1-2 years |
3-4 years |
5-7 l. |
8-10 l |
11-13 l |
14 l |
|
Weight |
7-10 |
11-14 |
15-18 |
19-24 |
25-35 |
36-50 |
50 and |
|
|
body |
more |
|||||||
|
sick |
||||||||
|
(kg.) |
||||||||
|
1st day |
0.5t |
0.5t |
1.5 t |
2.5t |
||||
|
2nd day |
0.25t |
0.5t |
1.5 t |
2.5t |
||||
|
3rd day |
0.25t |
0.25t |
0.5t |
|||||
Such treatment does not guarantee a radical cure for three-day malaria, since hemotoschizotropic drugs do not act on hypnozoites in hepatocytes, therefore the course of relief treatment with chloroquine must be supplemented with radical treatment.
For radical treatment using a histoschizotropic drug primaquine 0.25 mg⁄kg⁄day of base for adults for 14 days without interruption simultaneously with relief treatment with chloroquine. Reducing the course of primaquine to less than 14 days leads to relapses of malaria. The drug should be distributed by medical personnel directly according to the “into the patient’s mouth” principle.
The duration of the full course of treatment for three-day malaria (reversing and radical) is 14 days. The study of blood products is carried out three times - before starting to take chloroquine, on the 4th day of treatment and before discharge from the hospital.
Primaquine is contraindicated:
- pregnant and breastfeeding women;
- children under 4 years old;
- persons with deficiency of the enzyme glucose-6-phosphate dehydrogenase due to possible hemolysis.
Treatment of three-day malaria in pregnant women:
Treatment of tropical malaria
The main WHO strategy in the treatment of tropical malaria is to take into account the sensitivity of the pathogen to drugs in the country from which the patient came (see WHO annual appendix)
- Uncomplicated
1. Artemether in combination with lumefantrine (Artemether - 20 mg Lumefantrine - 120 mg)- Riamet
Treatment regimen for uncomplicated tropical malaria
|
Weight in kg |
Age in years |
Number of Riamet tablets and hours of administration |
|||||
|
0 hour |
8th hour |
24th hour |
36th hour |
48th hour |
60th hour |
||
|
5-14 |
Less than 3 years |
||||||
|
15-24 |
|||||||
|
25-34 |
9-14 |
||||||
|
35 or more |
More than 14 |
||||||
The combination of Artemether and Lumefantrine is contraindicated in pregnant women.
2. Mefloquine (Lariam, Meflaquine) 25mg base/kg in two doses - 15mg/kg plus 10 mg/kg with an interval of 6-24 hours between doses. Pregnant women in the first trimesters, with mental disorders and epilepsy are contraindicated.
3. Quinine in combination with doxycycline: Quinine (dihydrochloride or sulfate) 10 mg⁄kg + doxycycline 100 mg per day for 7 days simultaneously or sequentially (orally).
Treatment with quinine must be combined with antibiotics (tetracycline, doxycycline, clindamycin) to reduce the risk of early relapses.
Doxycycline is not prescribed to children under 8 years of age. Children under 8 years of age are prescribed quinine at a dose of 10 mg⁄kg. per day for 7 days. Children over 8 years old are prescribed quinine 10 mg⁄kg + doxycycline 2 mg⁄kg per day for 7 days
4. Combination of artesunate and sulfadoxine + pyrimethamine (Fansidar)
In combination treatment, the dose of artesunate is 4 mg/kg once daily for three days with one dose of sulfadoxine-pyrimethamine (orally)
|
Age |
Dose in mg (number of tablets) |
|||||
|
Artesunate (50 mg) |
sulfadoxine—pyrimethamine (500/25) |
|||||
|
1st day |
2nd day |
3rd day |
1st day |
2nd day |
3rd day |
|
|
5-11 months |
25 (1/2t) |
25 (1/2t) |
25(1/2t) |
250/12.5 (1/2 t.) |
||
|
1-6 years |
50 (1t) |
50 (1t) |
50(1t) |
500/25 (1 t) |
||
|
7-13 years |
100(2t) |
100(2t) |
100(2t) |
1000/50 (2t) |
||
|
More than 13 years |
200 (4t) |
200 (4t) |
200 (4t) |
1500/75 (3t) |
||
Complicated
1. Etiotropic treatment
A) Treatment is carried out by parenteral administration of quinine dihydrochloride 30% - 2 ml (600 mg), based on:
- loading dose of quinine - 20 mg of salt/kg, dissolved in 10 ml/kg of isotonic solution for four hours every 8-12 hours, slowly intravenously;
- then 10 mg/kg for four hours every 8-12 hours until the patient can independently take quinine sulfate tablets at a dose of 10 mg/kg salt every 8 hours for 7 days.
V) Artesunate first dose 2.4 mg per 1 kg / IV, or IM after the first dose, repeated after 12-24 hours (three times), then once a day for 6 days.
With) Artemeter first dose 3.2 mg per kg/m, 2.6 mg kg for 6 days. Pregnancy is a contraindication for the use of artemisinin preparations.
2. Patient management and symptomatic treatment for complications:
a) with cerebral malaria- accounting for the volume of injected and excreted fluid; measuring the patient’s body temperature every 4-6 hours, respiratory rate, blood pressure. To prevent seizures, phenobarbital 10-15 mg/kg intramuscularly; if seizures occur, diazepam 0.15 mg/kg IV or paraldehyde 0.1 mg/kg IM;
b) with anemia- hematocrit below 20% - transfusion of red blood cells, with normal kidney function - together with 20 mg of furosemide;
c) with renal failure- careful administration of an isotonic solution under the control of venous pressure; peritoneal dialysis or hemodialysis if oliguria persists after rehydration and the concentration of urea and creatinine in the blood rises;
d) with hypoglycemia- glucose 50% - 50 ml IV, subsequently, if necessary, 5% or 10% glucose IV; for children - 1.0 ml/kg;
e) with pulmonary edema- half-sitting position; oxygenation (including artificial ventilation); furosemide 40 mg IV, if there is no effect, increase the dose progressively to 200 mg; in case of pulmonary edema due to excess hydration, stop IV fluids, immediate hemofiltration, furosemide from 40 to 200 mg IV;
f) with hyperpyrexia in children- repeated measurement of temperature in the rectum, if it rises above 39°C, active cooling of the body with a damp towel and fan, paracetamol 15 mg/kg (suppositories, nasogastric tube);
Treatment of vaccine (schizont) malaria
Monitoring the effectiveness of treatment
In case of three-day malaria, the study of blood products should be carried out on the 4th day of treatment, i.e. upon completion of relief treatment and before discharge, i.e. upon completion of radical treatment.
For tropical malaria, daily microscopy of a blood sample is indicated during the treatment period. If gametocytes are still detected after treatment, the patient should be treated with a one-day dose of primaquine (0.45 mg base for adults) to prevent malaria mosquitoes from infecting him during the malaria transmission season.
Conditions of discharge
Convalescents of three-day and tropical malaria are discharged after complete clinical recovery, completion of a radical course of treatment and a negative result of a blood product test before discharge.
Persons who have not received radical treatment with primaquine (pregnant women, children under 4 years of age, etc.) undergo anti-relapse treatment after removal of contraindications, for 14 days, on an outpatient basis.
If the period of contraindications coincides with the season of malaria transmission, they can receive seasonal chemoprophylaxis with chloroquine once a week according to age.
Available antimalarial drugs
|
Preparation |
English Name |
Tick prevention |
Treatment |
Notes |
|
Artemether-lumefantrine |
Artemether-lumefantrine |
commercial name Coartem |
||
|
Artesunate-amodiaquine |
Artesunate-amodiaquine |
|||
|
Atovaquon-proguanil |
Atovaquone-proguanil |
commercial name Malarone |
||
|
Quinine |
Quinnine |
|||
|
after the appearance |
||||
|
Chloroquine |
Chloroquine |
resistance use |
||
|
limited |
||||
|
Cotriphazide |
Cotrifazid |
|||
|
Doxycycline |
Doxycycline |
|||
|
Mefloquine |
Mefloquine |
commercial name Lariam |
||
|
Proguanil |
Proguanil |
|||
|
Primaquin |
Primaquine |
|||
|
Sulfadoxine-pyrimethamine |
Sulfadoxine-pyrimethamine |
Dosage schedule for chloroquine treatment (WHO)
|
Number of tablets |
||||||||||
|
Weight (kg) |
Age (years) |
Tablets, 100 mg |
Tablets, 150 mg |
|||||||
|
Day 1 |
Day 2 |
Day 3 |
Day 1 |
Day 2 |
Day 3 |
|||||
|
< 4 мес |
0.25 |
0.25 |
||||||||
|
7-10 |
4-11 months |
|||||||||
|
11-14 |
||||||||||
|
15-18 |
||||||||||
|
19-24 |
||||||||||
|
25-35 |
8-10 |
|||||||||
|
36-50 |
11-13 |
|||||||||
Treatment of uncomplicated malaria
|
Chloroquine- |
|||
|
sensitive |
|||
|
P.vivax and P. |
Adult dose |
Child dose |
Notes |
|
falciparum |
|||
|
(imported) |
|||
|
600 mg base |
10 mg base |
||
|
Chloroquine (orally) (Aralen®) |
(1000 mg phosphate salt), then 300 mg (500 mg) 6 hours later, |
(max 600 mg base) orally, then 5 mg/kg 6 hours later, |
See Table1 |
|
and 300 mg base, 2 days |
and 5 mg/kg base, 2 days |
||
|
Chloroquine-resistant P.vivax |
Adult dose |
Child dose |
|
|
Mefloquine (oral) (Lariam®) |
1,250 mg (in 2 divided doses: 750 mg + 500 mg 8-12 hours later), 1 day |
< 45 |
CANNOT be used by pilots and public transport drivers |
|
kg |
|||
|
Quinine sulfate + doxycycline (orally) |
650 mg every 8 hours (3-7 days + doxycycline 100 mg/day, 7 days |
25 mg/kg/day in 3 divided doses, 3-7 days + doxycycline 2 mg/kg/day up to 100 mg, 7 days |
Doxycycline: CONTRAINDICATED in children under 8 years of age and during pregnancy |
|
Prevention of P. vivax relapse |
Adult dose |
Child dose |
|
|
CONTRAINDICATED |
|||
|
15 mg base |
pregnant women and |
||
|
Primaquine (orally) |
(26.3 mg phosphate salt) daily (14 days) |
0.3 mg base (0.5 mg salt) per kg/day, 14 days |
breastfeeding women and those with G6PD deficiency Chloroquine-resistant P. falciparum (imported) |
|
Chloroquine- |
|||
|
resistant P. falciparum |
Adult dose |
Child dose |
|
|
(imported) |
|||
|
Quinine sulfate (orally) |
650 mg every 8 hours, 7 days |
10 mg/kg every 8 hours, 7 days |
Very bitter, zinconism (nausea, dysphoria, tinnitus) |
|
* Tetracycline |
250 mg every |
CANNOT be prescribed to children and |
|
|
(inside) |
6 hours, 7 days |
pregnant women |
|
|
* Doxycycline (orally) |
100 mg/day, 7 days |
NOT for use in children under 8 years of age |
PRECAUTION: May reduce the effectiveness of birth control pills |
|
* Pyrimethamine 25 mg / Sulfadoxine 500 mg (in one tablet) orally / |
2-3 tablets once, on day 2 |
6 weeks-1 year -1/4 tablet on day 2 1-3 years - ? tablet for day 2 4-8 years -1 tablet for day 2 |
PRECAUTION: if the patient is allergic to sulfur-containing drugs |
|
9-14 years old - 2 |
|||
|
tab for 2 days |
|||
|
Mefloquine (orally) |
1,250 mg (in 2 divided doses: 750 mg + 500 mg 8-12 hours later), 1 day |
25 mg/kg (in 2 divided doses: 15 mg/kg + 10 mg/kg 6 hours later);< 45 кг |
Nausea, vomiting, dysphoria, weakness, nightmares |
|
11-20 kg: 1 tab |
|||
|
Malarone (Atovachone 250 mg + Proguanil 100 mg) orally |
4 tablets, in one dose, 3 days |
3 days 21-30 kg: 2 tablets in one dose, 3 days 31-40 kg: 3 |
Expensive |
|
tab in one |
|||
|
reception, 3 days |
|||
|
< 15кг: по 1 |
|||
|
Riamet (Artemether 20mg+Lumefantrine 120mg) |
4 tablets, twice a day, 3 days |
tablet twice, 3 days 15-25kg: 2 tablets twice, 3 days 25-35 > kg: each |
Effective against multidrug-resistant P. falciparum |
|
3 tabs twice |
|||
|
3 days |
* Prescribed together with quinine
Treatment of severe chloroquine-resistant falciparum malaria (antimalarials)
Intravenous
Adult dosage
Pediatric dosage
(IV) injections
20 mg salt/kg (saturation dose),
20 mg salt/kg (dose dissolved in 10 ml/kg saturation), dissolved in isotonic liquid, IV
10 ml/kg isotonic drip over 4 hours, liquid,
IV drip in Quinine (VV)
then, 8 hours after 2 hours, then through the start of the saturation dose, 10 mg 12 hours after the start of the dose of salt/kg for 4 hours of saturation, 10 mg salt/kg every 8 hours until within 2 hours every 12 the patient will be able to swallow for hours until
|
Must complete 7- |
the patient will be able to swallow |
|
|
daily course of quinine tablets |
Must complete 7- |
|
|
(10 mg salt/kg every 8-12 |
daily course of tablets |
|
|
hours) |
quinine (10 mg salt/kg every |
|
|
8-12 hours) |
||
|
Artesunate (VV) |
2.4 mg/kg (loading dose) IV on day 1 followed by 1.2 mg/kg daily for at least 3 days until patient can swallow |
|
|
Intramuscular |
||
|
ed VMs |
||
|
injections (if |
Adult dosage |
Pediatric dosage |
|
BB |
||
|
not available) |
||
|
Quinine (QM) |
20 mg salt/kg, dissolved at a rate of 60-100 mg/ml, IM, then, 8 hours after the start of the saturation dose, 10 mg salt/kg every 8 hours until the patient can |
Same as adults (according to weight) |
|
swallow |
||
|
Artemether (VM) |
3.2 mg/kg (saturation dose), IM on day 1, then 1.6 mg/kg daily for at least 3 days until patient can swallow |
Same as for adults (according to weight) It is recommended to use 1 ml tuberculin syringes due to the small volume |
|
Rectal |
||
|
candles (VV/VM |
Adult dosage |
Pediatric dosage |
|
not available) |
||
|
40 mg/kg (saturation dose), |
||
|
Candles with |
rectally, then 20 mg/kg via |
Same as for adults (in |
|
artemisinin |
according to weight) |
|
|
oral treatment |
||
|
Artesunate suppositories |
200 mg rectally at 0, 4, 8, 12, 24, 36, 48 and 60 hours, followed by oral treatment |
Malaria Surveillance Protocol
Epidemiological surveillance is the process of systematic collection and analysis of epidemiological data for the purpose of planning and carrying out anti-epidemic measures to prevent, detect, suppress the spread of infection, as well as evaluate their effectiveness, to protect public health and the environment.
The purpose of epidemiological surveillance is to maintain well-being in rehabilitated areas and prevent the restoration of local transmission and spread from imported cases of malaria.
I. Main tasks of healthcare institutions.
1. Improving malaria surveillance system
II. Main functions of epidemiological surveillance:
III. The malaria surveillance system includes:
2. Ecological, entomological, epidemiological and socio-demographic monitoring of the malaria situation:
- analysis of meteorological data (temperature and humidity);
- analysis of the socio-demographic situation (population migration, economic activity);
- determination of the level of malariogenicity of the territory and zoning according to the risk of malaria infection;
- entomological observations of the vector and their breeding sites.
3. Organization and implementation of anti-malaria activities:
- hydraulic engineering measures and preventive sanitary
- supervision during the construction and operation of irrigation structures;
- environmentally friendly vector control measures
- (larvicidal measures, gambusation of breeding sites of malaria mosquitoes);
- providing the population with means of protection against insect bites;
- public health education;
- prevention of vaccine malaria.
- 4. Training of medical personnel in the diagnosis, treatment, epidemiology and prevention of malaria.
- 5. Assessing the effectiveness of anti-malarial measures taken.
- 6. Interdepartmental and intersectoral integration and coordination of anti-malaria activities.
1. Collection and analysis of information on the incidence of malaria.
- Active detection.
Early identification of patients with malaria is carried out by health workers during door-to-door or door-to-door visits based on a log with family lists of residents and dates of visits. All persons suspected of malaria are subject to thermometry and a blood sample is taken (a thick drop and a thin smear). In the log, a note about the visit is made in the line against each person interviewed and a note about taking blood from those suspected of malaria.
1. 2. Laboratory diagnosis of malaria
The main method for diagnosing malaria is the examination of a thick drop and a thin smear of blood stained according to Romanovsky-Giemsa. Cooking technique drugs.
Blood for testing for malaria is taken from a finger onto a clean, grease-free glass using a disposable sterile scarifier. Place 2 thick drops on one glass, and a thin smear on the other (as an exception, you can prepare a thick drop and a thin smear on one glass). After drying, with a simple pencil, the index of the medical institution (the index of the medical institution is assigned by the Reference Laboratory) that took the blood and the serial number of the drug, corresponding to its serial number in the blood collection register, are marked on the edge of the smear. Referrals to the laboratory are completed for blood products. Blood products taken from patients with fever are immediately sent to the laboratory with the note “urgent” on the order. If a resident suspected of having malaria during the malaria transmission season received a single dose of chloroquine as a preliminary treatment before receiving a response from the laboratory, this is noted in the referral to the hospital.
1.3. Ensuring the quality of laboratory diagnostics of malaria -
carry out control over the completeness and timely laboratory examination of patients for malaria at all stages of medical care in health care facilities, over timely examination and reporting of results. Delays in research deadlines are unacceptable.
Reviewed blood products are stored in primary laboratories for 3 months in a special box or box. Positive drugs (with malaria pathogens) from health care facilities are sent for confirmation to the etrap and velayat laboratories of the SES and then to the OPC. External quality control of laboratory diagnostics.
Components of external control:
- confirmation of all positive drugs;
- control of at least 10% of negative drugs once a month during the transmission season, and outside the season once every 3 months (the timing and number of the drug for testing are reported by the control laboratory).
1.5. Registration, notification, accounting and reporting on malaria, information flow.
1.5.1. Registration of malaria cases
As a result of the epidemiological survey, it is determined epidemiological category case:
- vaccinated- the case when infection is carried out by blood; the remaining four categories are cases of infection through mosquitoes:
- imported-case of infection outside the given territory (country);
- recurrent - a case of local infection that occurred a long time ago, before the break in transmission in the outbreak; in the case of three-day malaria, it is usually accepted that the infection occurred earlier than in the previous epidemic season; the remaining two categories are cases of recent infection:
- secondary from imported-a case the source of which was an imported case;
- local- a case whose source of infection was any other case and is the result of local transmission.
1.5.2. Alert
1.1.5.3. Accounting
The registration of malaria incidence at the etrap (city) SES level is carried out on the basis of emergency notifications (f.058/u) received from treatment and preventive institutions. Registration forms - a log of infectious patients, a map of the epidemiological examination of the patient and the outbreak, a log of door-to-door visits, a log of registration of feverish patients, a log of taking and examining samples in the laboratory.
2.1.5.4. Report
Reporting forms on the incidence of malaria, a report on the implementation of mass chemoprophylaxis and others are provided from the etrap (city) level to the velayat level, then to the OPC and State SES, according to the accounting and reporting forms.
1.5.5. Feedback
A malaria information flow diagram is attached.
1.6. Surveillance and monitoring of malaria outbreaks
Primary care
The following types of malaria foci exist:
- Pseudofoci- populated areas where transmission is impossible due to lack of heat or lack of a vector. The remaining six categories (2-7) are outbreaks:
- Healthy hearth- a populated area in which transmission is possible, but absent for at least two epidemic seasons, not counting the current one (longer periods may be accepted). There are no cases. The remaining five categories (3-7) are localities where there are cases. Of these, new lesions (3 and 4) arise from recovered ones:
- New potential outbreak-a populated area where imported or inoculated cases appear during the effective mosquito infestation season, but there is no evidence that transmission is occurring.
- New active outbreak- a focus where transmission occurs after a long break, which is proven by the presence of secondary cases from imported cases, as well as local ones. In contrast to new outbreaks, residual(5 and 6) occurred earlier than during the current epidemic season.
- Residual active lesion-the focus where transmission occurs or occurred in the last epidemic season.
- Residual inactive lesion- a focus where transmission has stopped, there are only recurrent cases. If the measures are insufficient, then the outbreak may go into a state more or less close to what it was before the start of the measures. The SES conducts constant monitoring of outbreaks, maintains a database on outbreaks - a file cabinet of outbreaks, which reflects their dynamics, and periodically prepares reports on their condition.
The transitions of the focus from one state to another are shown in the figure.
1.7. Analysis of malaria incidence and situation.
Indicators of the work of treatment and preventive institutions are the time from the onset of the disease to the patient seeking medical help, the time from treatment to diagnosis, to taking blood products, to referral for research, to viewing the drug in the laboratory, to sending an emergency message and to hospitalization of the patient.
The date of onset of the disease makes it possible to calculate the approximate date of infection. To do this, the possible duration of the incubation period is subtracted from the date of onset of the disease: 7 days for tropical, 10 days for three-day, 14 days for oval malaria and 25 days for four-day malaria. Taking into account the amount of heat in the time preceding the possible date of infection, it is possible to calculate how long it took for the pathogens to develop in the mosquito’s body and obtain the latest possible date of infection of the mosquito that bit the patient. Knowing the date, it is possible to determine whether this bite incident was the cause of infection for this patient.
To assess the degree of establishment of three-day malaria and determine the scope of antimalarial measures in the service area, a differentiated accounting of local and secondary from imported cases of diseases is necessary. To assess the possible role of the patient as a source of new cases of malaria, the time required for completion of sporogony in a mosquito and the minimum incubation time in humans for a given type of pathogen are added to the date of onset of the disease.
When analyzing epidemiological survey cards of patients with tropical malaria, attention should be paid to the previous use of drugs for chemoprophylaxis, compliance with their dosages and regimen of use.
The incidence of malaria (the ratio of the number of cases detected over a period of time to the number of a given population) is calculated for adults per 100 thousand population, and for children per 1000. Incidence analysis is carried out by calendar years, but for three-day malaria it is more convenient to use the “epidemiological” year - the period from the beginning manifestations of infection of a given season before the onset of primary manifestations of infection of the next transmission season. In this case, a distinction is made between the period of the malaria season (months with the largest number of diseases) and the off-season period (the remaining months). A primary manifestation in the summer of a given year and a relapse in the spring (without treatment with primaquine) of the next year in one patient is counted as 1 case.
2. Ecological and epidemiological analysis of conditions affecting the spread of malaria.
For effective planning and rational implementation of anti-malarial measures, monitoring of the situation is necessary: epidemiological, entomological, environmental, socio-demographic.
2.1. Entomological supervision.
Entomological surveys are carried out in foci of malaria (in residential and commercial premises), as well as in all anophelogenic reservoirs. The data is entered into the map of the epidemiological survey of the outbreak and into the passports of reservoirs.
Collections of the pre-imaginal phases of mosquito development are necessary to establish breeding sites and seasonal changes in their area, seasonal changes in the number of larvae, and assess the effectiveness of mosquito extermination measures.
There should be several control reservoirs, taking into account their likely colonization by different Anopheles species. Control reservoirs should not be populated by larvicidal fish and should not be treated with larvicidal preparations - this is necessary to record the seasonal variation in the number of vectors undisturbed by human influence and to adequately assess the effectiveness of anti-larval measures in reservoirs of similar types.
In parallel with identifying the larvae of vectors, the entomologist must monitor the temperature regime of control reservoirs of different types. Observations are carried out once a decade during the entire period of vector activity. The results are entered into the reservoir passport.
Observations of the progress in the number of adult mosquitoes consist of two components: recording the number of adult mosquitoes during their days and recording the number of adults attacking the host.
One of the main indicators for assessing the seasonal dynamics of the number of endophilic malaria vectors is the regular counting of winged mosquitoes in control rooms - day houses. Monitoring of the seasonal dynamics of mosquito numbers should be carried out by counting them in barns and living quarters at least once a decade. To select control days, premises in the estate (sheds, cellars, living rooms, etc.) are first examined for the presence of mosquitoes in them and the most favorable ones for examination are selected. In each village, at least 10 control estates should be selected.
Collections of mosquitoes are carried out with an exhauster and always using an electric flashlight. The most accurate method is to completely catch all mosquitoes in the room, which is acceptable only if the number of mosquitoes is low, and if the number is high, you need to treat the room with a 0.2-0.3% solution of pyrethrin in kerosene using a hand sprayer, after covering the floor with a white cloth, with so that it is easier to count the number of fallen mosquitoes. In the absence of an exhauster, catching mosquitoes can be carried out using a regular test tube. It is most convenient to place the caught mosquitoes in a cage, where a label is placed indicating the number of the control day, its type, date, time of recording and the name of the collector. The number of mosquitoes is represented as an average number per 1 m2, or per room.
Exophilic mosquitoes choose vegetation, tree hollows, ditches, pits, caves and other suitable shelters as their day-time sites. Depending on the weather or changes in local conditions, mosquitoes can change their days. Therefore, when counting numbers, you should choose an area that includes all possible types of days. After establishing day-keeping periods, each time the population is counted, it is necessary to survey the same area at least once every 7-10 days. The main condition for the reliability of the results obtained is regular catches in the same areas, by the same collectors. The time of the examination - in the morning and the first half of the day - must be precisely fixed; during the examination, all Anopheles mosquitoes should be caught with an exhauster and placed in a cage. At the end of catching, the number of caught mosquitoes is recalculated per 1 person/hour of catching.
In addition, when collecting exophilic mosquitoes, you can use a “macro cage” (a mill-gas-type mesh mounted on a parallelepiped-shaped frame). With this “macro-garden,” the assistants cover the census taker, who collects all the mosquitoes flying out of the grass and, at the same time as collecting them, scares them out of the vegetation and picks up the remaining ones. Since the base area of the macrocage is known or can be determined, the number of mosquitoes caught can be represented as the number of specimens per 1 m2. If during a ten-day period 2 or more catches were carried out in the village, then the average number per ten-day is derived from them. During the observation process, it is necessary to keep graphs of the seasonal dynamics of mosquito numbers for each species.
To collect mosquitoes that attack humans, you need an exhauster, an electric torch and a container for the caught mosquitoes. The collector, in a sitting position, exposes the shins of his legs and, periodically illuminating them with a flashlight, collects attacking mosquitoes (i.e. catching on himself). Be sure to make sure that while fishing there are no strangers or animals nearby that distract the mosquitoes.
The abundance indicator is the number of mosquitoes collected by one collector in 1 hour during the daily peak of the attack. The attractiveness of different people to mosquitoes varies, so it is better to use a group of collectors. It is impossible to carry out surveys during strong winds or rain - this will distort the results of the study. Animals (cows) can be used as bait, which usually attract more mosquitoes, but in this case it is difficult to assess the danger of the vector to humans.
2.2. Zoning (stratification) of territory depending on malariogenic potential.
The main task of zoning during the period of malaria elimination is a comprehensive assessment of the malariogenic potential of the territory and its “vulnerability” and “susceptibility”, mapping the results, assessing the situation, forecasting and rational planning of preventive measures.
The zoning process includes:
- analysis of data from meteorological stations (average daily temperatures and humidity);
- study of the habitats of malaria vectors;
- analysis of species abundance based on long-term data; - determination of the period of effective infectivity of malaria mosquitoes;
- assessment of transmission season structure;
- determination of the malariogenic potential of the territory.
The main preventive measures are: reducing breeding sites and reducing the number of vectors, protecting the population from insect bites.
3. Organization, planning and implementation of anti-malaria activities.
The annual plan must contain 4 main sections: -organizational and methodological activities; -preventive measures; -improving knowledge and training of medical personnel; - health education of the population.
For each event, deadlines and performers (responsible persons) must be clearly established. The last vertical column contains a mark on the completion of this activity. The scope of activities should be expanded during the epidemic season when there is an influx of people for construction or agricultural work, as well as in populated areas with common mosquito breeding grounds. The length of the incubation period of three-day malaria requires planning antimalarial measures in the outbreak for the next 2 years after registration of the last malaria patient. A.
Preventive measures.
1) Hydraulic measures are aimed at preventing, reducing or eliminating breeding sites for malaria mosquitoes and reducing malariogenic potential. Specialists of the Sanitary and Epidemiological Service carry out preventive sanitary supervision during the design and construction of hydraulic structures and the operation of potentially dangerous anophelogenic reservoirs.
One of the prerequisites for the construction of reservoirs is a detailed and timely development of a forecast of changes in the malariogenic situation in the zone of their influence. Within reservoirs, the main danger as a breeding ground for mosquitoes is shallow water overgrown with aquatic vegetation. Reducing the area of shallow waters is achieved by selecting the marks of the retaining horizon, as well as by deepening, backfilling, embanking, etc. Thorough cleaning of the reservoir bed from bushes and forests reduces the possibility of it becoming overgrown with vegetation and reduces the breeding of mosquitoes.
During the construction and operation of irrigation systems, it is necessary to comply with sanitary requirements, which include repairing the walls of canals or rollers, regular cleaning of canals, timely discharge of excess water into water intakes, elimination of temporary or permanent swamps that arise along canals, and the construction of special sluices that facilitate proper distribution of water. Minor hydraulic engineering activities are carried out by economic organizations on the basis of a comprehensive plan and according to the instructions of the sanitary and epidemiological service in the order of current sanitary supervision, as well as by residents of outbreaks on personal plots.
The population, religious and public organizations, and environmental protection agencies should be involved in monitoring the implementation of preventive measures. It is necessary to provide hygiene training to the population to protect against insect bites.
2) Biological methods are based on the use of agents of biological origin (biological insecticides based on entomopathogenic bacteria) and predators (primarily larviphagous fish, for example, gambusia) in the fight against the pre-imaginal stages of development of malaria mosquitoes.
Most biological insecticides (bactoculicide, larviol, bactericide) used in the fight against Anopheles mosquito larvae are produced on the basis of the bacterium Bacillus thuringiensis israelensis (Bti), the death of the larvae occurs after absorption of particles of the drug containing toxins.
The positive properties of bacterial insecticides include their selective effect on mosquito larvae and safety for non-target fauna of water bodies. The disadvantage is the short residual effect, as a result of which the frequency of treatment of reservoirs is 1 time in 10-15 days. The consumption rates of drugs depend on the concentration of the active substance (bacterial toxin) and the formulation.
The use of larvifagous fish (i.e. fish that eat mosquito larvae) is a fairly effective and relatively inexpensive method of regulating the number of Anopheles. The most widely used larviphage is Gambusia affinis. Colonization of permanent reservoirs with mosquito fish is carried out, as a rule, only once, then the fish reproduce themselves and to increase their efficiency, it is only necessary to clean the reservoirs from excessive overgrowth with vegetation, primarily filamentous algae.
3) Providing the population with means of protection against insect bites.
Repellent preparations are applied to the skin, they are used to treat clothes, bed curtains, mosquito nets, and curtains. The active ingredients in repellent preparations are diethyltoluamide (DEET), preparation 3535 (ethyl-3N-butylacetamidopropionate), oxamate, acrepe, essential oils (lavender, geranium, clove, etc.).
For application to the skin, repellents are used in the form of creams, gels, emulsions, and aerosols. The duration of the protective effect of repellents applied to the skin is several hours (1-5), depending on the nature of the activity, because the drug is washed off later, washed off, and partially absorbed through the skin. To treat facial skin, the repellent is applied to the palm of the hand, which is then lightly lubricated on the face, avoiding contact of the drug with the eyes and mucous membranes of the nose and mouth. The period of protective action of repellents applied from aerosol cans to the skin is 2-4 hours. To treat clothing, nets, curtains, individual sections of tents, etc., 30% water emulsions of repellents are used.
To protect sleeping people, curtains made of fabric and gauze are used. Currently, long-acting curtains impregnated with synthetic pyrethroids are produced. The edge of the canopy should be folded under the mattress. To prevent mosquitoes from flying into tourist tents, it is advisable to selectively treat individual areas of the tent (near the entrance, windows) with repellents.
You can protect your room from mosquitoes by screening windows, ventilation holes, vestibules, and doors. To do this, use a mesh with a cell size of 0.8 mm, its edges are secured with slats. It is possible to use mesh and tulle curtains impregnated with repellents.
To kill mosquitoes indoors, residents can use insecticidal-repellent cords and coils containing allethrin. The death of insects in the premises after the start of smoldering of the spiral begins within 20-30 minutes. Cords and spirals are recommended for use in well-ventilated areas or outdoors (canopies, verandas, etc.).
When using electric fumigators (plates or liquid), evaporation is designed for 6-8 hours of operation; a set of liquid in electric fumigators lasts for 40 days with daily use from 1 to 6 hours.
4) Prevention of vaccine malaria. Basic requirements: -residents of active outbreaks cannot be donors; -territorial SES submit lists of active foci of malaria once a year to blood transfusion points; - for health reasons, blood transfusions and organ transplants are carried out from donors from residents of the outbreaks with the prescription of chloroquine to the recipient (course dose 25 mg/kg body weight).
5) Chemoprophylaxis of malaria
Individual chemoprophylaxis
Individual chemoprophylaxis serves for personal protection of persons traveling to countries where malaria is endemic (workers, students, tourists, businessmen, diplomatic delegations, transport workers, etc.)
Organizations sending employees to countries in the tropical zone, or travel agencies organizing trips to these countries, are required to inform travelers about the need to comply with measures to prevent tropical diseases, including malaria. Before traveling, travelers must consult with a doctor in the office for the control of tropical diseases at the OPC and purchase an antimalarial drug recommended for individual chemoprophylaxis in the area (Table No. 2).
Organization and implementation of seasonal chemoprophylaxis and inter-seasonal preventive treatment of the population. Mass seasonal chemoprophylaxis with chloroquine is carried out in the active outbreak during the season of malaria transmission according to epidemic indications (Table No. 2). Interseasonal preventive treatment of the population with primaquine is carried out after the end of the transmission season or before the start of the next epidemic season to prevent late manifestations of 3-day malaria. The form for analyzing the implementation of interseasonal preventive treatment of the population is indicated in table No. 3, which is filled out by specialists of the treatment and preventive institution and transferred to the OPC, the log of implementation is in table No. 4.
The map of the epidemiological survey of a malaria outbreak should indicate the type of outbreak and classify the malaria case.
Activities carried out in outbreaks of different categories:
c) residual active focus- carry out a set of antimalarial measures specified in paragraph b), plus seasonal chemoprophylaxis of the population and in the spring of next year - preventive treatment with primaquine for the same residents of the outbreak.
d) inactive focus- remains under observation, preventive measures are taken.
d) improved focus- continue to carry out sanitary educational work among the population and entomological surveillance of the vector. In the event of an outbreak, take from the emergency plan (Headquarters, daily collection of information, analysis and development of emergency measures to prevent further spread of infection).
B. Health education of the population.
His tasks include:
- Acquisition by the population of an understanding of the initial, earliest and characteristic signs of the disease, the need to immediately seek medical help.
- Creation of certain skills among the population that help prevent the occurrence of disease cases. The population should contribute to the implementation of measures in the event of the emergence and spread of malaria.
During the implementation of anti-malaria activities in endemic areas, weekly workshops, monthly conferences, and annual seminars are required, since the exchange of experience, information, and improvement of staff knowledge are important.
4. Training of national personnel.
Personnel training on the issues of combating and preventing malaria is carried out as planned in pre- and post-graduate medical education institutions. Forms of training may include long-term (1-2 months) courses and cycles of specialization and improvement, thematic seminars (1-5 days), scientific and practical conferences.
5. Assessing the effectiveness of anti-malarial measures taken.
Evaluation of the effectiveness of identifying patients with malaria.
The blood test index is one of the main indicators characterizing the work to identify patients. This indicator is calculated by dividing the number of individuals surveyed for a certain period by the population size and expressed as a percentage. The coverage of the population by examination must correspond to the capabilities of the laboratory service, since when laboratories are overloaded, the quality of research decreases. In malariogenic areas, screening 3% of the population per month during the malaria season is sufficient.
To assess the work of health care facilities in identifying sources of infection, it is necessary to determine the population coverage in time and space (by month and locality), the multiplicity by age (0-11 months, 1¬4 years, 5-9 years, 10-14 years, 15- 19 years old, 20-59 years old, 60 and older). The optimal period from illness to treatment is 1 week, from treatment to diagnosis 1-3 days.
Evaluation of clinical and laboratory diagnosis of malaria.
Evaluation of the effectiveness of chemoprophylaxis in the population.
In active foci of malaria, the effectiveness of seasonal and interseasonal chemoprophylaxis is assessed by analyzing reporting forms filled out by doctors. The assessment takes into account the completeness of coverage of the population, compliance with the timing of administration and age-specific dosages of drugs. Usually, the high effectiveness of seasonal and inter-seasonal chemoprophylaxis is evidenced by the rapid rate of decline in morbidity and the improvement of the focus over 2 epidemic years.
Assessing the effectiveness of malaria vector control measures.
The effectiveness of these measures is assessed by the number of mosquitoes. To do this, compare the number of mosquitoes in the treated settlement with the number in the previous year. If the treatment is carried out with persistent insecticides, the effect of the treatment is noticeable immediately and depends on the coverage of the premises by the treatments. With 80-100% coverage and an effective insecticide, mosquitoes disappear within 24 hours. Single individuals flying from water bodies can still be caught within 2 weeks (brooding from larvae). In the future, mosquitoes will be absent until the insecticide wears off. When treatments cover 50-60% of the premises, mosquitoes disappear gradually and complete disappearance can be expected only after 20-30 days. With a coverage of 30-40%, mosquitoes disappear only by the end of the second month.
6. Interdepartmental and intersectoral coordination of anti-malaria activities.
The problem of combating malaria is multi-sectoral and requires coordination of the Ministry of Health with the ministries of other departments: agriculture, water resources, internal affairs, economics and development, finance, as well as local government and public organizations. Integration is achieved both through direct contacts of key stakeholders from different departments, as well as decisions of boards, ICC, state administrations, or joint decisions of different departments.
Table No. 1 Scheme of personal chemoprophylaxis for those traveling to countries endemic for tropical malaria
|
Territories |
Preparation |
Dosage |
Dosage regimen for adults |
||
|
with availability |
|||||
|
or |
|||||
|
lack of |
|||||
|
resistant |
|||||
|
sti to p/m |
|||||
|
drugs |
|||||
|
Without |
Chloroquine |
5 mg |
Before departure |
During |
After |
|
sustainability |
tabl. 0.250 |
base/kg |
stay |
return |
|
|
and to |
(150 mg |
body weight |
in the country |
nia |
|
|
chloroquine |
base) |
1 time per week |
|||
|
or |
1 week before departure |
300 mg base |
once |
||
|
10 mg base/kg body weight, 6 |
1 day before |
once a week |
but per week, 4 weeks |
||
|
days in the week (Sunday break) |
departure |
100 mg base per day - 6 |
after returning |
||
|
days in |
|||||
|
week |
|||||
|
Without stability |
Proguanil 0.200+ |
200 mg per day + |
4 weeks |
||
|
and to chloroquine |
Chloroquine 0.100 |
100 mg per day |
1 day before departure |
1 table per day |
after return |
|
(or combinations |
1 table per day |
1 table |
1 table V |
||
|
an) |
day |
||||
|
Mefloquine* |
4 weeks |
||||
|
sustainability |
(Lariam) |
5 mg/kg b.w. 1 time |
1-3 days before |
1 table V |
after |
|
yu |
tabl. 0.250 |
per week |
departure |
a week |
return |
|
To chloroquine |
1 table each V |
nia |
|||
|
and fansidaru |
day |
1 table V |
|||
|
a week |
|||||
|
Doxycycline |
1.5 mg/kg.m. t. in |
1 day before |
1 table V |
4 weeks |
|
|
polyresist |
** |
day |
departure |
day |
after |
|
ness |
(Vibramycin |
1 table 100 mg per |
1 table |
return |
|
|
) |
day |
nia |
|||
|
mefloquine, |
tabl. 0.100 |
1 table V |
|||
|
fansidaru, |
day |
||||
|
quinine) |
|||||
|
With polyresistance (to mefloquine, Fansidar, quinine) |
Atovaquone *** 250 mg -Proguanil 100 mg Combination tablets (Malarone) |
11-20 kg -Atovaquone -62.5 mg Proguanil - 25 mg (1 children's tablet) 21-30 kg-(2 children's tables) 31-40 kg-(3 children's table) more than 40 kg- 1 |
1 day before departure 1 tablet. |
1 table per day Duration: up to 3 months |
7 days after return of 1 tablet. per day |
|
adult table |
Note * - not prescribed to pregnant women in the 1st trimester, children weighing less than 5 kg, and persons taking ß-blockers. Causes loss of coordination. **- not prescribed to children under 8 years of age, pregnant women, and women during lactation. Causes photosensitivity. ***-not prescribed for pregnant women and children weighing less than 11 kg.
Table No. 2
|
Event type |
Drugs and dosage regimens |
Indications |
|
Mass (seasonal) chemoprophylaxis |
Chloroquine 300 mg once a week |
In foci of tertian malaria during the human transmission season |
|
Residual population |
||
|
Mass |
Primaquine 15 mg |
or new active lesions |
|
preventive |
grounds in |
three-day malaria for |
|
treatment of the population |
day |
relapse prevention |
|
(off-season) |
14 days (adult) |
and primary manifestations after prolonged incubation. |
Table No. 3
Analysis of the implementation of inter-seasonal preventive treatment of the population with Primaquine.
|
Days |
Not subject to prophylactic treatment |
||||||
|
including |
|||||||
|
distributions |
Yes |
Number |
Children |
Pregnant |
Feeding |
Other |
|
|
teacher |
You |
populated |
Total |
to |
for the first time |
tions |
anti- |
|
rata |
leniya |
and the latest |
mothers |
indications |
|||
|
year |
3 months |
||||||
Continuation of the table
Subject to preventive treatment Total 9 10 Not covered including Temporarily absent Complications Refusal from the drug Total coverage -chen about % coverage to the total population % coverage to the number of those subject to preventive treatment 11 12 13 14 15 16
Table No. 4
Primaquine chemoprophylaxis logbook.
|
Full name |
age |
address |
Days to take primaquine |
Total days of taking the drug |
Notes on violation of the drug dosage regimen |
||||||||||||||||
|
Failures |
absence |
notes |
|||||||||||||||||||
Note:
“Clinical protocol for the treatment of malaria” and “Protocol for epidemiological surveillance of malaria” were approved by the educational and methodological council of the National Institute of Health of the Ministry of Health of the Republic of Armenia on December 11, 2009.
