Malaria treatment guideline of Government of Nepal.

Malaria is endemic disease in Nepal.

The most common causative agent being plasmodium vivax and plasmodium falciparum. Plasmodium malariae has not been reported in the last 20 years and no cases of plasmodium ovale.

Of the total malaria cases 17-25% cases were plasmodium falciparum cases.

No deaths have been reported after 2014 in Nepal due to malaria and its associated complication.

Anopheles fluviatis and Anopheles annularis are the most common mosquito associated with malaria in Nepal.

The guideline provided by the government of Nepal for the treatment of malaria include the following drugs and regimens. The drugs are available free of cost at health post across the highly susceptible areas of Nepal.

Treatment of Uncomplicated Vivax malaria

Day 1	Chloroquine 600mg (10mg/kg) (4 tabs)	Primaquine 0.25mg/kg (2 tabs)
Day 2	Chloroquine 600mg  (10mg/kg) 4 tabs	Primaquine 0.25mg/kg (2 tabs)
Day 3	Chloroquine 300mg (5mg/kg) 4 tabs	Primaquine 0.25mg/kg (2 tabs)
Day 4-14		Primaquine 0.25mg/kg (2 tabs)

1 tab Choloroqine = 150mg base

1 tab primaquine = 7.5mg

Primaquine is contraindicated in children < 6 months and breastfeeding ladies.

If the status of the patient about G6PD deficiency can not be ruled out, Primaquine 0.75mg/kg once a  week for 8 weeks to be used.

Treatment of uncomplicated falciparum malaria

Day 1	Coartem 4 tab 2 doses 12 hours apart (Artemether 80mg and Lumefantrine 480mg.)
Day 2	Coartem 4 tab 2 doses 12 hours apart (Artemether 80mg and Lumefantrine 480mg.)
Day 3	Coartem 4 tab 2 doses 12 hours apart (Artemether 80mg and Lumefantrine 480mg)	Primaquine 0.25mg/kg (2 tabs) single dose

Coartem is a Artimesinin Combination therapy (ACT) and consists of Artemether and Lumefantrine in a combination of 20mg  and 120mg of drugs respectively.

1 tab primaquine = 7.5mg

In first trimester of pregnancy, Coartem is not recommended and hence quinine isused.

Tab Quinine 10mg/kg (2 tabs) q8hrly for 7 days

 1 tab quinine = 300mg

Treatment of Complicated falciparum malaria

For >20kg BW Inj Artesunate 2.4mg/kg BW IV/IM at stat (0), 12 hours and every 24 hours then after For <20kg Inj Artesunate 3mg/kg BW IM at stat (0), 12 hours and every 24 hours then after

OR

Inj Artemether 3.2mg IM stat and 1.6mg IM once daily

OR

Inj Quinine 20mg/kg stat BOLUS dose over 4 hours in D5 or DNS solution Inj Quinine 10mg/kg q8hourly MAINTAINENCE dose with the drug not exceeding 5mg/kg/hour

Once the patient tolerates oral medication start on ACT/Primaquine or Quinine therapy as in uncomplicated falciparum malaria.

Artesunate can be given in any trimester of pregnancy.

Malaria treatment Guideline recommended by Government of Nepal.
Source: http://edcd.gov.np/malaria-treatment-chart

For more details of malaria control and treatment of Nepal, visit http://www.edcd.gov.np/publications/category/27/Malaria.