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Infectious

Malaria

ملیریا

High-grade fever with rigors and chills that subsides with sweating, acute onset, with no focal symptoms (no sore throat, cough, runny nose, loose stool, abdominal cramps or burning micturition).

ICD-10
—
Source
OPD handbook pp.71–76
Status
Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

  • High-grade fever
  • Rigors and chills
  • Fever subsides with sweating
  • Acute onset
  • Non-focal: no sore throat, no cough or runny nose, no loose stool or abdominal cramps, no burning micturition

Diagnosis

  • Vitals: temperature 103–105 °F, pulse 140–150/min
  • Rest of the examination unremarkable
  • Labs: CBC (the book notes eosinophilia, i.e. raised eosinophils)
  • MP (malarial parasite): direct observation under the microscope

Treatment

Step 1 of 5

1. Antimalarial: lumefantrine + artemether (adult weight bands)

Brands: One-3 (20/120, 40/240, 80/480), Tab Arceva (20/120, 40/240, 80/480), Tab Gen-M (20/120, 40/240, 80/480).

  • Weight 80 kg: Tab One-3 80/480, 2 tablets stat then 1+1 for 2 days
  • Weight 40 kg: Tab One-3 40/240, 2 tablets stat then 1+1 for 2 days
  • Weight 20 kg: Tab One-3 20/120, 2 tablets stat then 1+1 for 2 days
  • Take the tablets with milk (per the Urdu note in the sample prescription)

Prescription

Artemether + LumefantrineArtemisinin combination therapy (ACT)
Dose2 tablets stat, then 1+1 (weight-band strength)
Brand One-3 / Arceva / Gen-M 2 more days
Also sold as Coartem, One-3, Arceva, Gen-M
Caution: Take with fatty food or milk; Avoid in first trimester unless no alternative
Step 2 of 5

2. Antimalarial: paediatric dose

  • Timequin sachet (dihydroartemisinin + piperaquine) daily for 3 days: up to 9 kg 1 sachet; 9–18 kg 2 sachets; 18–27 kg 3 sachets
  • Put the sachet in milk (per the sample prescription)

Prescription

Dihydroartemisinin + PiperaquineArtemisinin combination therapy (ACT)
DoseUp to 9 kg: 1; 9–18 kg: 2; 18–27 kg: 3 sachets daily
Brand Timequin sachet 3 days
Step 3 of 5

3. Antipyretics

If fever is above 102 °F.

  • Remove excessive clothes
  • Sponging with cold water until temperature is below 102 °F
  • Keep spirit swabs under the armpits (axilla)
  • IV antipyretic indicated if the patient cannot take or cannot tolerate oral (e.g. vomiting): Inj Provas 1 g/100 mL; adult 1 g TDS; paediatric 10–15 mg/kg or 1.5 mL/kg TDS (e.g. 10 kg → 15 mL TDS)

Prescription

Paracetamol (Acetaminophen)Analgesic / antipyretic
DoseAdults: 2 tabs stat then TDS
Brand Tab Panadol 500 mg (alternate brands: Febrol, Pedrol, Calpol)
Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)
Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease
Paracetamol (Acetaminophen)Analgesic / antipyretic
DoseChildren: 10 mg/kg TDS
Brand Syp Panadol 120 mg/5 mL
Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)
Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease
Paracetamol injectionAnalgesic / antipyretic
DoseAdult 1 g TDS; paediatric 10–15 mg/kg TDS
Brand Inj Provas 1 g/100 mL
If cannot take oral
Step 4 of 5

4. Appetizer

  • The patient complains of loss of appetite in malaria

Prescription

Appetizer / multivitamin syrupAppetite stimulant / tonic
Dose2 tsf (e.g. Lysovit 2 tsf 2+2 before meals)
Brand Syp Trimetabol 2 tsf; Syp Lysovit; Syp Nesbol; Syp T-Metabol
Also sold as Trimetabol, Lysovit, Nesbol, T-Metabol
Step 5 of 5

5. Counselling

  • Use more fruit and vegetables
  • Use mosquito nets and spray at home

Sample prescriptions from the book (patient details removed)

  • Male, 30 y, 70 kg, fever 1 day with rigors and chills and body ache; T 103 °F, pulse 138: Sponging; Inj Provas 1 g stat. Discharge: Tab One-3 80/480, 2 tablets together then 1+1 for two days with milk; Tab Panadol 500 mg 2+2+2; Syp Lysovit 2 tsf 2+2 before meals. CBC may show eosinophilia; MP may be positive. Use more fruit and vegetables; mosquito nets and spray at home.
  • Girl, 6 y, 16 kg, fever 1 day with vomiting 3 episodes, no loose stools; T 104 °F, pulse 148, dry tongue: Sponging; spirit swab under armpit; Inj Provas 24 mL IV stat; Inj N/S 500 mL IV stat; Inj Gravinat 1 cc IV in IV fluid. Discharge: Timequin sachet, 2 daily in milk; Syp Calpol 6 Plus 250 mg/5 mL 1 tsf 1+1+1; Syp Gravinat 2+2+2 spoons if vomiting; Syp Trimetabol 1 tsf 1+1. Adv: CBC, MP.

Verify before use

  • The book lists 'eosinophilia' as the expected CBC finding in malaria; standard texts more commonly report thrombocytopenia and anaemia. Have a clinician confirm.
  • Brand strengths for One-3: the first line of the scan reads 80/840, while the dose section uses 80/480; 80/480 is used here.
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