NATIONAL DRUG POLICY

ON
MALARIA
(2010)
Objectives of National Drug Policy
 Access: equitable availability and affordability
of essential drugs
 Quality: safety and efficacy of all medicines
 Rational use: the promotion of therapeutically
sound and cost effective use of drugs by health
professionals and consumers.
National Drug Policy on Malaria
 The main purpose of National Drug Policy on
Malaria is to provide a framework for the safe and
effective treatment of uncomplicated and severe
malaria as well as prevention of malaria in travelers
and vulnerable groups, such as pregnant women
and young children.
 National Drug Policy on Malaria
 First formulated in 1982
 Reviewed and revised periodically

Aims at:
 Providing complete cure (clinical & parasitological).

 Preventing progression into severe malaria.

 Prevention of relapses.

 Interruption of transmission.

 Preventing development of resistance.

Criteria for change of Drug Policy
 Drug policy is changed for the area/Block PHC
reporting 10% or more total treatment failure
(ETF+LTF) to the tested drug i.e. the currently
used antimalarials in a sample of minimum 30
P.falciparum test cases.
 Diagnosis
All fever cases suspected to be malaria should be investigated by:
 Microscopy:

Sensitive, parasite load can be estimated

Possible to distinguish different species
 Rapid Diagnostic Test (RDT):

Detect malaria antigen (HRP-2/pLDH)

Should be provided in remote locations

In cases where parasitological diagnosis is not possible due to non-availability of

microscopy or RDT, suspected malaria cases will be treated with full course of
chloroquine till the result of microscopy are received.
 Treatment of P. Vivax cases
1. Chloroquine X 3 days 10 mg/kg on days 1 & 2
followed by 5 mg/kg on day 3
2. Primaquine X 14 days 0.25 mg/kg
 Treatment of P. Vivax cases
1. Chloroquine X 3 days 10 mg/kg on days 1 & 2
followed by 5 mg/kg on day 3
2. Primaquine X 14 days 0.25 mg/kg

Presumptive treatment with Chloroquine is not

recommended
 Treatment of P. Vivax cases
1. Chloroquine X 3 days 10 mg/kg on days 1 & 2
followed by 5 mg/kg on day 3
2. Primaquine X 14 days 0.25 mg/kg
Tablet
Tablet Chloroquine (150 mg base) Primaquine
Age in (2.5 mg base)
years Day 1 Day 2 Day 3
Day 1 to Day 14
<1 ½ ½ ¼ 0
1-4 1 1 ½ 1
5-8 2 2 1 2
9 - 14 3 3 1½ 4
15 & above 4 4 2 6
 Treatment of P. Falciparum
Artemisinin based combination therapy (ACT)

Day 1 Day 2 Day 3

Artesunate Artesunate
4mg/kg BW 4mg/kg BW
Artesunate
4mg/kg BW
Sulfadoxine
(25mg/kg BW) + Primaquine
Pyrimethamine 0.25 mg/kg BW
(1.25 mg/kg BW)
 Age wise dosage schedule for
P.Falciparum cases

Day 1 Day 2 Day 3

Age in
years Artesunate S+P Artesunate Primaquine Artesunate
(50 mg) (500+25) (50mg) (7.5mg base) (50 mg)

<1 ½ ¼ ½ 0 ½

1–4 1 1 1 1 1
5–8 2 1½ 2 2 2
9 – 14 3 2 3 4 3
15 & above 4 3 4 6 4
 Treatment of uncomplicated
P. Falciparum cases in pregnancy

1st Trimester 2nd Trimester 3rd Trimester

Quinine
ACT as per ACT as per
10mg/kg BW
schedule schedule
tid X 7 days
 Treatment of severe Malaria cases

Drug Dosage Route Remarks

Artesunate 2.4 mg/kg BW IV / IM 0h,12h,24h →od
Treatment of severe Malaria cases

Drug Dosage Route Remarks

Artesunate 2.4 mg/kg BW IV / IM 0h,12h,24h →od
3.2 mg/kg BW
Artemether ↓ IM od
1.6 mg/kg BW
Treatment of severe Malaria cases

Drug Dosage Route Remarks

Artesunate 2.4 mg/kg BW IV / IM 0h,12h,24h →od
3.2 mg/kg BW
Artemether ↓ IM od
1.6 mg/kg BW
Arteether 150 mg IM od X 3 days
 Treatment of severe Malaria cases

Drug Dosage Route Remarks

Artesunate 2.4 mg/kg BW IV / IM 0h,12h,24h →od
3.2 mg/kg BW
Artemether ↓ IM od
1.6 mg/kg BW
Arteether 150 mg IM od X 3 days
20 mg/kg BW
Quinine ↓ IV / IM tid
10 mg/kg BW
↓
Quinine+ 10 mg/kg BW tid X 7 days
Doxycyclin 3mg / kg BW Oral od X 7 days
Or
Clindamycin 10mg/kg BW bd X 7 days
ACT for 3 days after parenteral therapy
 Resistance should be suspected if in spite of full
treatment, patient does not respond with in 72 hrs,
clinically and parasitologically.
 They should be treated with oral quinine with
Doxycyclin and reported to concerned Distt./State
Malaria officer for initiation of therapeutic efficacy
studies.
Chemoprophylaxis
 Only in selective groups in high pf endemic areas.
 Short term (up to 6 wks): Doxycyclin 100mg od 2
days before travel & continued 4 weeks after
leaving malarious area.
 Long term (more than 6 wks) : Mefloquine 250 mg
weekly 2 weeks before & 4 weeks after exposure.
THANK YOU
 Epidemiological Profile : India (2008)

 Total Population : 1091 million

 Population in malarious areas : 981.9 million
 No. of lab confirmed cases : 1.53 million
 Pf proportion : 50%
 No. of deaths due to malaria : 1061
 High transmission areas: 26%
 Low transmission areas: 64%
 Malaria free: 10%
Malaria Situation in India

. . -----
Chloroquine Resistant Areas (1978-2008 August)