Formulate a plan of management

Problem list
1. Chills, high grade fever
2. severe headache and body malaise
3. anemia
4. hepatospleenomegaly

FEVER
- Provide paracetamol/acetaminophen
- do a tepid sponge bath

MALARIA
- Artemisinin-based combinations (ACTs)
- First line treatment for uncomplicated falciparum malaria
- drug combinations and not with single drugs in endemic areas
- artemisinin derivative for 3 days plus antimalarial drug
- artemether-lumefantrine
- artesunate-mefloquine
- MEFLOQUINE is associated with increased rates of vomiting and dizziness
- dohydroartemisinin-piperaquine
*cure rates >90%
* patients should be monitored for vomiting for 1h after the administration of any antimalarial drug
* antimalarial quinolones exacerbate the orthostatic hypotension associated with malaria
* if there is any doubt in identifying infecting malarial species, treatment for falciparim malaria should be
given
* non immune patients receiving treatment for malaria should have a daily parasite counts performed
until the thick films are negative
- IF level of parasitemia does not fall below 25% of the admission value in 48h OR if parasitemia has
not cleared for 7days, DRUG RESISTANCE is likely and the regimen should be CHANGED

TO TREAT RECRUDESCENCE

- AS SECOND LINE TREATMENT FOR RECRUDESCENCE following first line therapy, different
ACT regimen may be given OR a 7day course of either artesunate or quinine plus tertracycline,
doxycycline, or clindamycin

PREVENT RELAPSE
- to eradicate persistent liver damage and prevent relapse(radical treatment), primaquine should be given
daily for 14days
* check for lab test for G6PD deficiency
* if negative proceed
* if positive, PRIMAQUINE 0.75mg of base/kg (45mg maximum) once weekly for 8 weeks