2. Life cycle of malaria parasite & sites of drug action
• Radical cure
• Causal prophylaxis
• Clinical cure
• Suppressive prophylaxis
Gametocidal

3. Anti malarial drugs
Blood schizontocide Tissue schizontocide
 4-Aminiquinolone
 Chloroquine ++ 0
 Arylamino alcohols
 Quinine ++ 0
 Mefloquine ++ 0
 Antimetabolites
 Proguanil + +
 Pyrimethamine + 0
 Sulfadoxine + 0
 Dapsone + 0

4. Blood schizontocide Tissue schizontocide
 Antibiotics
 Tetracycline + +
 Doxycycline + +
 Minocycline + +
 8-Aminoquinolone
 Primaquine 0 +
 Newer drugs
 Phenanthrene methanol
 Lumefantrine ++ 0
 Halofantrine ++ 0
 Artimisinin derivatives
 Artemether + 0
 Artesunate + 0

5. New guidelines for the treatment of malaria in Sri Lanka
Anti Malaria campaign, May 2008
Treatment of microscopically / Rapid Diagnostic Test(RDT)
confirmed P.vivax malaria
All patients should be given a course of chloroquine base at a
dosage of 25mg/Kg over three days.
This dose should be divided as follows & given as a single dose per
day :
1st day – 10mg/Kg
2nd day – 10mg/Kg
3rd day – 5mg/Kg

6. All these patients should also be given a course of
Primaquine base at a dose of 0.25mg/Kg per day over a
period of 14 days (Radical cure)
Primaquine is NOT given in pregnant mothers, infants &
patients with glucose-6-phosphate dehydrogenase
(G-6-PD) deficiency
One tablet of chloroquine contains 150mg of
chloroquine base
One tablet of primaquine contains 7.5mg

7. Treatment of microscopically/RDT confirmed
uncomplicated P.falciparum malaria
All P.falciparum infected patients should be admitted to a medical
institution where Artemether-Lumefantrine ( Coartem®) is
available
The weight appropriated colour of blister packs & dosage (in
number of Coartem® tablets) is as follows:
5 - <15kg
(yellow)
15 - < 25kg
( blue)
25 - <35kg
(orange)
> 35kg
(green)
0 hours 1 2 3 4
8 hours 1 2 3 4
24 hours 1 2 3 4
36 hours 1 2 3 4
48 hours 1 2 3 4
60 hours 1 2 3 4
Total 6 12 18 24

8. Chemoprophylaxis for travelers
to endemic areas
Regimen 1
Mefloquine one 250mg tablet weekly OR
Doxycycline one 100mg capsule daily OR
Malarone (atovaquone and proguanil)one tablet daily
Regimen 2
Chloroquine 300mg weekly ( 2 x 150mg tabs) PLUS
Proguanil 200mg daily (2 x 100mg tabs)
Regimen 3
Chloroquine 300mg weekly OR
Proguanil 200mg daily

9. Regimen 4
No prophylactic tablets required. But anti mosquito
measures should be strictly observed.
Avoid mosquito bites by covering up with clothing such
as long sleeves & long trousers especially after sunset
Using insect repellents on exposed skin
When necessary, sleeping under a mosquito net

10. Drug safety
Pregnancy Breast Feeding
 Chloroquine ok ok
 Paludrine ok ok
 Mefloquine ok no
 Doxycycline no no
 Malarone no no

11. Individual Anti Malarial drugs
Chloroquine
Mechanism of action :
Chloroquine is concentrated within the infected RBC’s
and interferes with degradation of heamoglobin by the
parasitic lysosomes resulting in plasmodial membrane
damage.
It is active against the blood forms & sexual forms
Ineffective against many strains of Plasmodium
falciparum
Safe in pregnancy

12. Adverse effects
 Nausea
 Vomiting
 Anorexia
 Uncontrollable itching
 Epigastric pain
 Retinal toxicity