Chemoprophylaxis of tropical malaria. Clinical (palliative) chemoprophylaxis of malaria

The main chemoprophylaactic drug chlorookhin is taken in the form of salts of chlorohin phosphate at a dose of 8.5 mg / kg every week. The reception start 2 weeks before departure to the endemic-malaria zone and regularly continue throughout the entire period of stay in it within 6 weeks after return. For young children and the first year of life there are liquid drugs chlorohin all over the world, except the United States. Chlorochin or other chemoprophylactic events do not prevent infection, but warn clinical manifestations during the reception period. Reception within

Southeast Asia, East Africa and Brazil. The combination of two drugs is distinguished by the high risk of severe adverse reactions until the occurrence of death. In this regard, the reception of chlorohin is recommended for the period of less than 3 weeks. If, in the history, there are no indications of the intolerance to sulfanimamides, leaving must have a pyrimetamine-sulfayadoxin with them in the amount of one therapeutic dose, which should be taken with increasing body temperature. After this temporary measure, a medical institution is necessary in order to solve the issue of continuing the prevention of chlorochin. Therapeutic dose Pyrimetamine - Sulfadoxin is Lu tablets for children aged 2-11 months, / 2 tablets aged 1-3 years,

1 tablet aged 4-8 years, 2 tablets aged 9-14 years, for adults and teenagers 3 tablets. Persons planning to stay in high-risk zones with chloroquin pretentious plasmodium for more than 3 weeks, it is necessary to take into account the living conditions, the availability of medical care and local signs of malaria.

Combined prophylaxis using chlorohin and pyrimetamine - sulfadoxin can be carried out while man tolerates drugs. Side effects consist in skin manifestations and damage to the mucous membranes. Pediatric practice recommended doses of pyrimetamine 0.5 mg / kg and sulfadoxin 10 mg / kg used according to the schemes proposed for the treatment of chlorochin.

Since drugs do not provide full protection against malaria, it is necessary that travelers have modern information about the spread of malaria and in doubtful cases consulted in relevant centers. Other events such as mosquito nets, drugs from them are quite useful in defense and recommended travelers.

Traveling to other countries is conjugate with the change of temporary belts, latitudes, water quality and food and with exposure to the modified environment. Traveling should know how to prevent the impact of these changes, which can be expected from them, what are the clinical symptoms and where to get medical care. Most often there is a diarrhea of \u200b\u200btravelers. No preventive chemotherapeutic agent is ineffective and not necessarily, in connection with which they are not recommended. Traveling need to know quality drinking water And do not drink fresh vegetables and fruits, pre-carefully without washing them. Weak traveler diarrhea is resolved spontaneously. With a pronounced diarrhea, accompanied by a feverish condition, strong pain in the abdomen or blood intake in feces, it is required to consult a doctor. Parents should be warmed about the high sensitivity of children to dehydration and loss of electrolytes, and therefore they are advised to have several packets containing a mixture of substances to rehydrate. Two drugs - trimethoprimsulfamethoxazole and doxocyclin are effective for the treatment of many patients with diarrhea of \u200b\u200btravelers. However, the treatment of them should be carried out under the control of the doctor due to frequent side effects.

Seasonal chemoprophylaxisaims to prevent the development of the disease during the malarious season. Preparations recommended for this type of prevention affect the erythrocyte stages of the development of plasmodium and block the erythrocyte corogue of pathogens. In the widespread zones of PL.Falciparum strains, which are resistant to medicinal preparations, effective protection The disease provides MEFLOKHIN, which is taken at the rate of 1 time per week 250 mg. Alternative way Prevention serves a weekly reception of 300 mg of chlorohin in combination with pyrimetamine (50 mg 1 time per week) or proganil (200 mg daily). In the regions where the possibility of infection with drug-resistant pathogens of tropical malaria is unlikely, the chemoprophylaxis may be limited to the use of chlorohin (300 mg of the drug 1 time per week). During the high risk of infection with malaria (incidence among the local population, more than 50) is prescribed a strengthened scheme of chemoprophylaxis (300 mg of chlorohin 2 times a week).

In order to create in the blood of the protective concentration of drugs, the conduct of chemoprophylaxis should be started in advance. 1 week before the alleged visit to the endemic region in the transmission season, 250 mg of MEFLOKHIN (1 tablet) or 900 mg of chlorohin (3 tablets in one reception or 1 tablet daily for 3 days) is carried out. During their stay in an epidemic focus, maintaining the necessary level of drugs is provided by their regular use, and the same day of the week. After returning from the focus of infection, the preventive reception of antimalarial means should be continued for 4 weeks.

Preventive treatment It is carried out in order to quickly create in the blood of a high concentration of drugs that impede the development of the disease in conditions of increased risk of infection with malaria plasmodes. For prophylactic treatment, chloroquine is used. The preventive course is designed for 3 days, on the first day 1 g is prescribed, in the 2nd and 3rd - 0.5 g of the drug. This method is particularly effective to prevent cases of malaria disease among the personnel of military units during the period when the regular reception of them of preventive chemotherapy products is temporarily difficult or impossible.

Intersonal chemoprophylaxis Directed to prevent the development of three-day malaria cases with long-term incubation, which may occur after the malarious season is completed. It is held at the beginning of an inter-epidemic period to persons who are on endemic in three-day malaria territory during the malaria season. For the interseasonous chemoprophylaxis, Priahin applies to the tissue stages of the development of plasmodium. The drug is prescribed for 14 days daily at 0.015 g bases (3 tablets) in one reception or 1 tablet 3 times a day. The interseasonous chemoprophylaxis is not conducted by persons who have suffered a viral hepatitis for the last 6 months. Preventive treatment of Primachin in the regional epidemic period is also not conducted by patients treated on three-day malaria over the past malarious season and conducted with the help of Primahin prevention of the development of late recurrence of the disease.

Preventive treatment for Primachinit is carried out by persons returning after visiting the territories with a high risk of infection by the pathogens of three-day malaria. This measure is aimed at preventing the explosion of infection into non-hendemic regions, where the risk of restoring the transmission of pathogens and epidemic distribution of malaria is preserved. In contrast to the offseason chemoprophylaxis, a preventive treatment course (daily at 0.015 g of foundation for 14 days) is carried out immediately before returning to non-hendemic territory, regardless of the period of the epidemic season. Only contraindications for receiving it can be released from it. A stamp of prophylactic treatment is made on a travel certificate or selling a soldier ticket.

Date added: 2015-09-18 | Views: 1238 | Violation of copyright

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RCRZ (Republican Center for Health Development MD RK)
Version: Clinical protocols MOR RK - 2014

Malaria caused by Plasmodium Falciparum (B50), malaria caused by Plasmodium malariae (B52), malaria caused by Plasmodium Ovale (B53.0), malaria caused by Plasmodium vivax (B51)

Short description

Recommended
Expert Council
RGP on PFV "Republican Center
Health Development »
Ministry of Health
and social development
Republic of Kazakhstan
from "12" December 2014
Protocol No. 9.

Malaria (Malaria) - a group of anthroponous protozoal transmissive invasions caused by various types of malaria plasmas modes transmitted by the mosquitoes of the genus Anopheles, which is characterized by properly intermittent fever, anemia, splengepamethegali, jaundice, pronounced intoxication during paroxysms, malignant current during tropical malaria and the development of remote (exo-errocyte) Recurrements for malaria - VIVAX in the absence of radical treatment.

I. Introductory part

Protocol name: Tropical malaria

Protocol code:

Code (s) of the ICD - 10:

B50. Malaria caused by p.falciparum. Mixed infections are included with other types of malaria plasmas.
B51. Malaria caused by P. Vivax. Included: mixed infections caused by other plasmodia with the exception of P.Falciparum (B50)
B52. Malaria caused by P.Malariae. Included: Mixed infections caused by other plasmodia with the exception of P.Falciparum (B50), P. Vivax (B51)
B53.0 Malaria caused by P. Ovale.

Abbreviations used in the protocol:
WHO - World Health Organization
G6FDG - glucose-6 dehydrogenase phosphate
DVS - Disseminated intravascular coagulation
IVL artificial ventilation of the lungs
OAK - Common Blood Analysis
OAM - general urine analysis
OPN - acute renal failure
SMG - spinal fluid
CVD - central venous pressure

Protocol development date: year 2014.

Protocol users: Therapists, doctors common practice, Pediatricians, infectiousists, doctors / hospiters ambulance, obstetrician gynecologists, anesthesiologists-resuscitation.

Classification

Clinical classification

I. According to etiology:

Malaria caused by P. Vivax (Vivax malaria, three-day malaria);

Malaria caused by P. Ovale (OVALE-Malaria);

Malaria caused by P. Falciparum (tropical malaria);

Malaria caused by P. Malariae (four-day malaria);

Malaria- mixt (mixed, indicating pathogens).

II. On epidemiology:

Brown - case of infection beyond this territory (country);

Secondary from the browning - the case whose source served as a browse case;

Local - the case, the source of which served any other case and is the result of local transmission;

Recurrent - the case of local infection, which has happened long ago, before breaking the transmission in the focus; In the case of three-day malaria, it is usually assumed that the infection occurred earlier than in the past epidseason.

III. By the transmission mechanism of infection:

Transmissive (via mosquito bite);

Valid (buck) (through blood).

IV. On clinical manifestations:

Three day (Vivax - Malaria, Ovale - malaria and tropical malaria);

Four-day: (Malariae - malaria).

V. By severity of clinical manifestation:
. clinically pronounced (typical);

Vi. By severity:

Easy;

Medium-heavy;

Heavy;

Extremely heavy.

VII. According to the presence and absence of complications in tropical malaria:
. uncomplicated;
. complicated:

Cerebral form (malaria coma);

Infectious and toxic shock (malaria algey);

Hemoglobinurion fever;

Acute lung edema

Nephrotic syndrome

Gap splezen

DVS syndrome

VIII. By sensitivity to antimalarial drugs:

Resistant

Not resistant

IX. With the flow:

Primary (initial period, rapid period, reconvaluation period);

Repetitive

Recurrements: (by pathogenesis: exoeritrocyte and erythrocyte) in terms: early - up to 2 months. and late - after 2 months)

X. On combination with other diseases:

Malaria + somatic disease;

Diagnostics

II. Methods, approaches and diagnostic and treatment procedures

List of basic and additional diagnostic events

List of basic diagnostic measures

Main (mandatory) diagnostic surveys conducted on an outpatient level:

General blood analysis;

General urine analysis;

Additional diagnostic surveys conducted on an outpatient level:

Biochemical blood test (bilirubin common, straight and indirect, alaninotransferase, aspartaminotransferase, glucose, urea, creatinine);

The minimum list of the survey, which must be carried out in the direction of the planned hospitalization:

General blood analysis;

General urine analysis (urine on bile pigments);

Microscopy of thick drops and a thin smear of blood painted along Romanovsky GIMZE.

Main (mandatory) diagnostic surveys conducted at the stationary level:

General blood analysis;

General urine analysis;

Biochemical blood test (bilirubin common, straight and indirect, alaninotransferase, aspartaminotransferase, gammaglutamyltranspapeptidase, alkaline phosphatase, general protein, albumin, glucose, urea, creatinine);

Uzi organs abdominal cavity.

Additional diagnostic surveys conducted at the stationary level:

Biochemical blood test (blood electrolytes - potassium, determining the level of PO2, RSO2);

Coagulogram (blood coagulation time, activated partial thromboplastin time, prothrombin index or ratio, fibrinogen A, B, ethanol test, thrombin time, plasma tolerance for heparin, antithrombin III in the blood).

IFA on markers of viral hepatitis;

Spinal puncture (with the development of the malaria coma);

Measurement of daily diurea;

Radiography organs chest (with suspected bronchitis, pneumonia);

ECG (with the pathology of the cardiovascular system).

Diagnostic measures carried out at the stage of emergency medical assistance:

Collect complaints and anamnesis of the disease, incl. epidemiological;

Physical examination.

Diagnostic criteria

Complaints:

Characteristic paroxysms / Malari Triad: chills, heat, profuse sweating;

Intoxication: headache, weakness, reduction of appetite, arthralgia, Malgia, lower back pain, with severe flow: dizziness, nausea, vomiting, liquid chair;

In the Applane period, the health of the patients can be satisfactory.

Anamnesis:

Acute start;

The course of the disease:

In the initial period: the initial fever of the wrong type (up to 38-39 s); During the period of the rank: a correctly intermitted (intermitting) fever after 48 hours at a three-day and 72 hours at four-day malaria;

The attack of the fever is completed with a critical decrease in body temperature to normal values \u200b\u200b(without receiving antipyretic drugs);

Indication of the disease of the malaria in the past (relapse);

Violation of malaria treatment regimen (relapse).

Epidemiological history:

Stay / bits of mosquitoes in endemic in malaria countries over the past 3 years (Appendix 2);

Blood transfusion;

Organ transplant (in endemic countries);

Blood donors who visited over the past 3 years endemic in the malaria of the country;

The use of medical instruments of reusable use in violation of the rules of asepsis and antiseptics (risk group - injecting drug users);

Fruit infection during childbirth vertical path from a sick mother;

. "Airport" or "baggage" malaria (arrival of infected people / mosquitoes from endemic regions, including "transit" passengers through large transport hubs);

Employees of international airports and seaports;

Physical examination
During an attack:

In the period of chills: the pallor of the face, the skin of the limbs is cold to the touch, acricyanosis;

During the fever: face hyperemia; Vessel injection Scler, dry hot skin, shortness of breath, tachycardia, hypotension;

Pronounced sweating / profuse sweating after a critical reduction of fever.

After two or three attacks, it is found:

Pallor skin Pokrov;

Jaundice (subicoity);

Increasing the spleen;

Increase liver;

With severe disease:

Auscultative: Dry wheezes in the lungs in the development of bronchitis, humid pneumonia - with the edema of the lungs;

Moderate meteorism;

Liquid chair;

Oliguria (with the development of OPN)

Edems, hypertension (with the development of nephrotic syndrome, characterized for four-day malaria);

Hallucinations, nonsense, convulsions, violation of consciousness (under cerebral form).

Secondary latent period: After the cessation of the attacks: the temperature is normalized, but in part of the patients - the subfebrile temperature in the absence of plasma in the blood due to vegetative disorders or the addition of secondary infection.

Early recurrences (erythrocyte):

Develop in 2 weeks - up to 2 months after the end of primary malaria paroxysms;

Accompanied by characteristic clinical manifestations, but there is no initial fever, there is a lighter flow and fewer paroxysms.

Late recurrences (exoeritrocyte):

Develop after 2 or more months;

Accompanied by characteristic clinical manifestations due to the activation of exochirocyte (tissue) schizogony.

Malaria in pregnant women:

The risk of severe flow is especially in the 2nd and 3rd trimesters;

Frequent complications in the form of edema of light and hypoglycemia;

Pronounced anemia, especially in tropical malaria;

Sharp increase in spleen and liver;

Birth of low weight children;

Infection of the fetus of malaria (weak, underdeveloped, anemic children with significantly increased spleen and liver);

Risk of developing abortion, premature birth, postpartum complications and death (50%);

Frequent bacterial complications in the postpartum period.

Malaria in children:

Malaria in infants loses its typical features;

The attacks of the disease are expressed little or absent;

After the chills characteristic of the beginning of the attack, a sinusiness may arise, cooling limbs;

There is no abundant sweat, which usually end the attacks of malaria in adults;

The intergreacy periods expressed little, since the temperature remains elevated;

Meningheal phenomena may be observed;

Symptoms of meningoencephalitis (vomiting, convulsions, heavy toxicosis with cardiovascular failure);

Often intestinal dysfunction;

Anemia is rapidly developing, the size of the spleen and the liver increases.

The malaria clinic in older children is the same as in adults:

More pronounced intoxication (headache, dizziness);

Short-term tonic convulsions;

Liquid stool without pathological impurities;

Moderate abdominal pain, without a certain localization;

Rapid development of anemia (after 2-3 attacks);

Leukocytosis in the range of 10.0-15.5x109 g / l;

Difficulties of differential diagnosis;

Malaria should be assumed in the following cases :

Fever in the period up to 3 years after staying in the endemic region;

Fever in the period 3 months after hemotransphus or intravenous infusions;

Fever has a newborn in the first 3 months. life;

Fever unclear genes;

Splenomegaly unclear origin;

Anemia of unclear genes;

Fever, anemia, hepatosplegegaly unclear gene;

Acute feverish diseases during the transmission season of the malaria plasmodium (May-August).

Determination of severe malaria:
If the patient in the blood is detected by culls P. Falciparum and no other reasons for one or more clinical or laboratory signsthen you can classify as heavy malaria:
clinical data:

Violation of consciousness, coma

Prostration, total weakness (The patient is not able to walk or sit without help)

Anorexia

Generalized convulsions (more than 2 episodes within 24 hours)

Dyspnea, Respiratory Distress Syndrome (Respiratory Acidosis)

Circulatory collapse or shock (systolic blood pressure< 70 мм рт.ст. у взрослых и < 50 мм рт. ст. у детей).

Jaundice in combination with manifestations of lack of other vital functions

Hemogobinuria

Spontaneous bleeding

Elevation of the lungs (X-ray)

Laboratory data:

Hypoglycemia (blood glucose< 2.2 ммоль/л)

Metabolic acidosis (plasma bicarbonates< 15 ммоль\л)

Heavy normocitar anemia (HB< 50 г/л, гематокрит < 15%)

Hemoglobinuria

Hyperasemia (\u003e 2% / 100 000 / μl in regions with low malaria transfer or\u003e 5% or 250,000 / μl in regions with stable intensive malaria transmission)

Hyperlactatemia (lactate\u003e 5 mmol / l)

Renal failure (blood creatine\u003e 265Ed / l).

Laboratory research:
Oak:

Reducing the number of erythrocytes, the concentration of hemoglobin, aniso- and caustic acidosis;

An increase in the content of reticulocytes;

The trend towards thrombocytopenia, leukopenia with relative lymphocytosis, monocytosis, may be leukocytosis with neutropyllaise (in tropical malaria);

An increase in ESR;

Decreased hematocrit depending on the severity of the disease.

OAM:

Proteinuria (with the development of nephrotic syndrome, characterized for four-day malaria);

Cylindria, red blood cell (in tropical malaria).

Biochemical analyzes Blood:

Raising bilirubin due to indirect (erythrocyte hemolysis); straight (with the development of toxic hepatitis);

An increase in the level of aminotransferase (with the development of toxic hepatitis);

An increase in creatinine, residual nitrogen, urea (with the development of OPN);

Hypoglycemia (intoxication);

Boosting potassium;

Reducing plasma bicarbonates< 15 ммоль\л (метаболический ацидоз);

Hyperlactatemia (lactate\u003e 5 mmol / l)

Coagulogram: Reducing the prothrombin index, antithrombin III, fibrinogen in (with tropical malaria).

SME analysis: Increased pressure, protein content up to 1-2 g / l (in tropical malaria).

Instrumental research
Abdominal ultrasound: Splenomegaly, hepatomegaly, signs of acute renal failure (in tropical malaria);
Radiography of the organs of the chest: signs of bronchitis, pneumonia, pulmonary edema (in tropical malaria);
ECG: signs of myocarditis, diffuse changes in myocardium.

Indications for consultation of specialists:

Consultation of the resuscitator (the development of urgent states in tropical malaria (eighty edema, DVS syndrome, OPN, acute liver failure, brain edema, malaria coma);

Consultation of the neurologist (when developing symptoms of defeat nervous system, malaria coma);

Consultation of an ophthalmologist (for inspecting the eye bottom with a brain edema, in tropical malaria);

Consultation of the urologist and / or nephrologist (with the development of nephrotic syndrome at four-day malaria, OPN - in tropical malaria);

Consultation of the hematologist (with serious degree anemia);

Consultation of the obstetrician-gynecologist (pregnant women);

Consultation of the surgeon (with the development of symptoms of the "acute abdomen").

Differential diagnosis

Differential diagnosis

Table 1. Differential diagnostic criteria of malaria, depending on etiology

Table 2. Differential diagnosis of malaria

Nosology \\ Criteria	Start	Type of temperature curve	The presence of the Apirexia period between the attacks	Pathology from internal organs And their combination	Hemogram	Verification of diagnosis
Malaria	Acute	intermitty rover	there is	Hepamegalia Splenomegaly	Anemia, leukopenia	Detection of plasmodium malaria with microscopy thick drops and fine blood smear
Typhoid fever	Gradual, less as sharp	constant	not	Roseless rash, meteorism, diarrhea, pain in the right iliac region	Leukopenia, aezinophy Leah, Shardder Shift	Hemoculture, Urinoculture, Copkulture, Biloculture, Rland with Breathos antigen with increasing titers more than 2 times
Spicy brucellosis	Acute	remitty rover	not	Articular syndrome, neuralgia, neuritis, orchit	Leukopenia, relative lymphocytosis, accelerated soe	Hemoculture, Wright Reaction, Headlson Reaction, IFA, PCR
Leptospirosis	Acute	remitty rover	not	Pronounced pain in the calf muscles, lumbar region, kidney damage, liver, nervous system	leukocytosis	Microscopy in a dark field
Flu	Acute	remitty rover	not	Tracity Pneumonia (viral)	lakeing	Reef, IFA PCR
Lishmaniasis visceral	Gradual, less as sharp	Wave-shaped (abstract )	not	Hypophunction of adrenal glands, weight loss, periatnic, hepato splenomegaly	Aneozinophy Liya, neutropenia with shift to the left to myelocyte, lymphocytosis, monocytosis, agranulocytosis	Microscopy of bone marrow point
Septis sharp	Acute	Intermitty Remitty Herker, hectic	not	The presence of three and more foci	Leukocytosis with a shift of formula to MEELOCITS TZN anemia	Positive Naya hemoculture

Treatment abroad

Treat treatment in Korea, Israel, Germany, USA

Get advice on medical examination

Treatment

Treats of treatment:

Cutting sharp clinical manifestations;

Radical cure;

Warning of mosquito infection.

Tactics of treatment

Non-drug treatment:

Mode:

Seuming (malaria without complications);

Bed (with the development of complications).

Diet (easily friendly);

Diet number 5.

Diet number 7 (with the development of nephrotic syndrome).

Abundant drink up to 2.5-3.0 l liquid.

Medical treatment:

Treatment of patients with malaria caused by P. Vivax, P. Ovale, P. Malariae and P.Falciparum (In the absence of resistance to chlorochin):

. The relief of acute clinical manifestations is carried out by a hematosisotropic drug

Chlorochin doses * for the treatment of malaria in children:

Patient age	Chlorochin doses in 150 mg tablets
	0-3 months.	4-11 months.	1-2 years	3-4 years	5-7 years old	8-10 years old	11-13 years old	14 years
Patient weight (kg)	5-6	7-10	11-14	15-18	19-24	25-35	36-50	50
1st day	0,5	0,5	1	1	1,5	2,5	3	4
2nd day	0,25	0,5	1	1	1,5	2,5	3	4
3rd day	0,25	0,25	0,5	1	1	1	2	2

Chlorochin treatment does not guarantee complete, radical cure of three-day malaria, since hematoshizotropic drugs do not act on hypnosis in the liver, therefore the course of the bubble treatment should be complemented by the appointment of radical treatment with a histoshisotropic drug.

Radical seracy of VIVAX and OVALE malaria and radical chemoprophylaxis of vivax malaria with long-term incubation:

Primahin Diphosphate * (Primachinum Diphosphate-PQ) of 0.25 mg / kg adults and 300 μg / kg / day base for children PER OS Daily once from the 4th to the 17th day of treatment (14 days).
If the patient arrived from the countries of Oceania and Southeast Asia, the dose of Primahin is 0.5 mg / kg of body weight.
For radical treatment of malaria caused by p.vivax, resistant to Primachin (Chesson strains) The duration of the course of the priachin at a dose of 0.25 mg / kg per day for 21 days.
In tropical malaria, prescribed only in cases where the Gametocytes remain in the blood.
With a light or moderate degree of G6PD deficiency, Primahin at a dose of 0.75 mg base / kg of body weight should be used once a week for 8 weeks. With severe lack of G6PD, Primahin is contraindicated.
Reducing the course of treatment with Primahin less than 14 days leads to the recurrence of malaria.
The drug should be used patients in the presence of medical personnel on the principle of "in the patient's mouth".

The duration of the standard total course of treatment of three-day malaria (bubbling and radical) - 17 days (3 + 14).

Treatment of uncomplicated tropical malaria in non-immune persons:
MEFLOOKHIN MEFLOQUINE
- 1st scheme: 15mg / kg in 2 receptions with an interval of 6-8 hours (term dose of 15 mg of base / kg);
- 2nd scheme (in infecting in the countries of the Indochinese Peninsula - Cambodia, Vietnam, Thailand, with a decrease in the sensitivity to the MEFLUKHIN: 15 mg / kg in 2 receptions with an interval of 6-8 hours, after 12- 24 hours 10 mg / kg (exchange rate Dose 25 mg of base / kg).

Treatment of uncomplicated tropical malaria, three-day malaria, sustainable chlorohine (including travelers returning to non-hendemic countries):

. Saving sharp clinical manifestations

For adults:
Cinen * (dihydrochloride) 10 mg / kg / day per os (in 3 receptions) + doxycycline 100 mg (1 time per day) for 7 days simultaneously or sequentially through the mouth or clindamycin 10 mg / kg (in 2 reception) at the same time or sequentially through the mouth for 5 days.

For kids
- Up to 8 years: Cinenial 10 mg / kg / day. (in 3 receptions) + clindamycin (10 mg / kg twice a day) within 7 days.
- For children over 8 years old: Kinein 10 mg / kg / day. (in 3 receptions) + doxycycline 2 mg / kg / day (in 1 reception) within 7 days.

Treatment of quinine must be combined with antibiotics (doxycycline, clindamycin) in order to reduce the risk of early relapses.

Tropical malaria treatment, quinine resistant:
The main strategy of WHO in the treatment of this form of malaria is the consideration of the sensitivity of the pathogen to drugs in the country, from where the patient arrived. The best existing treatment, especially in the case of Malaria P. Falciparum, is a combination therapy (ACT) based on Artemisinin. Artemisinin (Artemisinin) (Havings extract) and its derivatives:

For adults:

1) ARTESUNAT * (AS) 2 mg / kg per day in 2 receptions within 3 days. Combined with doxycycline (3.5 mg / kg once a day) or clindamycin (10 mg / kg twice a day) within 7 days.

2) ARTESUNAT * (AS) 4 mg / kg per day in 2 reception within 3 days. Combined with meflohin 15 mg / kg on the 2nd day once.

Treatment of uncomplicated tropical malaria in pregnant women:
- In the first trimester Kinin * (dihydrochloride) 10 mg / kg / day per OS (in 3 receptions) + clindamycin 10 mg / kg (in 2 reception) simultaneously or sequentially through the mouth for 7 days. With the ineffectiveness of treatment: Artesunate * (AS) 2 mg / kg per day in 2 reception within 3 days. Combined with clindamycin (10 mg / kg twice a day) within 7 days.
- In the second and third trimester and lactation period: Artesunate * plus clindamycin for 7 days.

Treatment of complicated tropical malaria (Cerebral malaria, malaria algey) are carried out in the separation of intensive therapy.

For adults The initial dose of quinine can be administered in two ways:

Cinenine *, quinine. 7 mg of salt / kg intravenously drip for 30 minutes, then 10 mg of salts / kg intravenously drip for 4 hours (daily dose of 17 mg of salt / kg for 4.5 hours);

Cinenine *, quinine. 20 mg of salt / kg per 0.9% solution of sodium chloride (10 ml / kg) intravenously for 4 hours.

Supporting dose of 10 mg of salt / kg is prescribed intravenously by a 0.9% sodium solution of chloride at intervals of 8 hours (within 1.5-2 hours) until it is possible to switch to oral administration of the preparation of quinine sulfate in a dose of 10 mg / kg of salts every 8 hours, for 7 days + doxycycline 100 mg (1 time per day), for 7 days simultaneously or sequentially, through the mouth. The course of treatment is 7 days.
With the development of acute renal and liver failure, the daily dose of quinine should be reduced to 10 mg of salt / kg and introduce with a speed of 20 drops per minute. It is advisable to combine 100 mg with doxycycline per day for 7-10 days.
In the season of transmission of malaria after the end of the course of treatment, it is necessary to assign Primahin * at a dose of 45 mg of the base once.

For kids:

Therapy of the first line is artesunate * (in ampoule of 60 mg) 2.4 mg / kg intravenously or intramuscularly, then after 12 and 24 hours, then 1.2 mg / kg 1 time per day for 6 days

Cinenine *, quinine. The drum dose of quinine (15 mg \\ kg) is administered intravenously drip in a 5% glucose solution for 4 hours. Supporting dose (10 mg \\ kg) is administered within 2 hours with an interval of 12 hours (in the absence of artlesunate).

Alternative therapy (In the absence of effect it is recommended):
For adults:

Artlesunate * 2.4 mg / kg / k / in (60 mg in ampule is dissolved in 0.6 ml of 5% sodium bicarbonate, then in 5 ml of 5% glucose is immediately entered into / in jet). Then 1.2 mg / kg - 1 time per day after 12 -24 hours. Within 6 days.

Then MEFLOKHIN 25 mg / kg in 2 receptions after 8 and 24 hours.

Artesunate * (in ampule is 60 mg) 2.4 mg / kg, can be administered intramuscularly with subsequent injections at a dose of 1.2 mg / kg after 12 and 24 hours, and then 1.2 mg / kg daily for 6 days. If the patient can swallow medicine, the daily dose can be given orally.

Then MEFLOKHIN * 25 mg / kg in 2 receptions after 8 and 24 hours.

For kids:
. Artesunate * (in ampule is 60 mg) 2.4 mg / kg intravenously or intramuscularly, then after 12 and 24 hours, then 1.2 mg / kg 1 time per day for 6 days (first line therapy).

Treatment of complicated shape of tropical malaria It must be complex: etiotropic and pathogenetic (relevant therapy of complications). In all cases of severe malaria, prevention of exacerbation and evasion of minor side effects of chemotherapy are secondary.

Under development hemoglobinurian fever (Massive intravascular hemolysis as a result of intensive invasion or the use of some antimalarial preparations - Cinene, Primahin, in persons with a deficiency of G6FDG) cancel the drug that caused hemolysis.

Treatment of recurrent malaria It is carried out according to the standard treatment regimen of the primary attack of the corresponding form of the disease or change the treatment scheme.

Treatment of gametone (only in tropical malaria) is carried out by primahin * for 1-3 days at a dose of 0.75 mg / kg.

The treatment of mixed-malaria with tropical, is carried out as monoinfection (tropical malaria), followed by the treatment of Primachin according to the standard scheme or artesunate plus meflohin.

Pathogenetic treatment of severe and complicated malaria forms:

Disinfecting therapy - parenteral administration of isotonic solutions (0.9% sodium chloride solution, 5% dextrose solution, trisole, ringer solution under the control of FVD;

Under hypoglycemia less than 2.2 mmol \\ l - 40% decomriage solution;

Oxygen therapy;

With the development of uremic syndrome: non-corrosionable oliguria more than 48 hours, hypercalemia, improving the level of creatinine, etc. Signs of Uremia - hemodialysis;

With severe anemia (reduced hematocrit, up to 15-20%) - transfusion of erythrocyte mass or solid blood;

With the development of hemoglobinorial fever - prednisone 1-2 mg \\ kg per day, intramuscularly or intravenously within 2-3 days;

In hyperthermia above 38.5С: For children - paracetomol (acetaminophen) 15 mg / kg every 4 hours (orally or in the form of suppositories);

With the development of septicemia - antibiotics of a wide range of Ceftriaxone's action in \\ m or in \\ in

With the development of DVS vitamin K, SPP

Pi shipyard syndrome - diazepam 10 mg / 2 ml in \\ m

With the development of urgent states (pulmonary edema, brain edema, infectious and toxic shock, malaria coma, DVS syndrome - according to the protocol for the treatment of urgent states).

Drug treatment rendered on an outpatient level: not carried out.

Medical treatment provided at the stationary level

List of basic medicines:

Chlorochina * (chloride or diphosphate) (Chloroquine, CQ) (form of release: tablets of 100 and 150 mg of base)

Primachina Diphosphate * (Primachinum Diphosphat, PQ) (release form: Tablets of 3 mg and 9 mg)

Cinene * (dihydrochloride) (release form: tablets of 250 and 500 mg, ampoules 1 ml of 50% solution).

Clindamycin (release form: gelatin capsules for 75 mg - for children, 300 mg and 150 mg - for adults)

Doxycycline (release form: 100 mg capsules)

MEFLOKHIN * (form of release: tablets 250 mg of base)

Artesunate * (AS) (form of release: Tablet of 50 mg, 200 mg, ampoules for intramuscular and intravenous injections of 60 mg and solvent: ampoules with 5% bicarbonate soda)

Note: * - Preparations purchased as part of one-time import.

List of additional drugs:

NaCl solution 0.9% - 100, 200, 400 ml

Dextrose solution 5% - 400.0;

Dextrose solution 40% - 20.0;

Sodium Bicarbonate Solution 5%

Ringerger solution for infusions, 200 ml and 400ml

Trisole solution for infusion 200 and 400 ml

Freshly frozen plasma (SPP)

Paracetamol tablets of 0.2 and 0.5 g, rectal suppositories 0.25; 0.3 and 0.5 g

Vitamin K, ampoules 1% - 1.0 ml

Ceftriaxone powder for the preparation of the solution for injections, the bottle 1g, 2g;

Prednisone, ampoules 30 mg / ml, 25 mg / ml;

Furosemid, ampoules 10mg / ml 2.0 ml.

Diazepam, ampoules 10 mg / 2 ml

Medical treatment rendered at the stage of ambulance: When developing urgent states at the stage of emergency medical care (pulmonary edema, brain swelling, infectious-toxic shock, malaria coma - on the protocol for the treatment of urgent states at the stage of emergency medical care).

Other types of treatment: are not conducted.

Surgical interventionInpatient conditions:
Types of operations:

Splenectomy.

Indications for surgery:

Rule spleen.

Preventive actions
The purpose of the chemoprophylaxis is the impact on different forms of the life cycle of plasmodium malaria to prevent or significantly restrict the manifestation of its livelihoods.
Persons traveling to endemic territories are preventing travel companies, departments and organizations on the danger of infection with malaria, especially its chlorofalistic form, and pass a course of personal (individual) chemoprophylaxis against tropical malaria in case of departure.

The efficiency of chemoprophylaxis depends on the choice of the drug, its dose and the application scheme, which requires a doctor knowledge of the geographical features of the spread of all species forms of malaria, and, especially, the propagation of drug-resistant tropical malaria (Appendix 5).

Seasonal chemoprophylaxis is carried out in active foci (in the Republic of Kazakhstan, with the emergence of local cases of malaria only during the transmission season) to prevent mosquito contamination on chlorochin infection 1 time per week, respectively, age.

The cross-season chemoprophylaxis is carried out in active foci (in the Republic of Kazakhstan in the emergence of local cases) in the period between the malarious seasons (in March, April or October, November) for the impact of P.vivax and P.ValE formatocytes in hepatocytes (the scheme is the same as in treating).
Mandatory requirement is the regularity of the drug and compliance with dosages (instruction of medical workers and the population). It is necessary not less than 90% coverage of the inhabitants of the hearth.

Measures primary prophylaxis:

Installing the mesh on windows and doors to protect against damping insects (in the epidemiological season).

Measures on timely identification of malaria :
Survey by microscopy of thick drops and fine smear of the blood of the next contingent:
- persons who arrived from endemic-malaria territories and visiting endemic territories over the past three years: when registering or under clinical indications, when any of the following symptoms appear: temperature rise, chills, indisposition, headache, liver, spleen, jaundice Scler and skin, herpes, anemia (Appendix 2);
- patients with fevering over three days in the epidemic season in malaria and within five days during the rest of the year;

Patients with continued periodic lifts of body temperature, despite the treatment carried out in accordance with the diagnosed diagnosis;
- recipients when increasing body temperature in the last three months after blood transfusion;
- Persons who have suffered with malaria: for any disease, accompanied by an increase in temperature;
- donors before surrendering blood.

Further maintenance

Conditions of statement :
Patients with three-day and tropical malaria are discharged after complete clinical recovery, the end of the radical course of treatment (17 days) and a 2x-multiple negative result of the study of the drug of blood (on the 4th day of treatment and before discharge).
Persons who have not received radical treatment (pregnant women) are subjected to anti-inflicted treatment after removal of contraindications, within 14 days, outpatient conditions. If the opposition period coincides with the malaria transmission season, they can receive the seasonal chemoprophylaxis of chlorochin 1 time per week, respectively, age.

Indicators of the effectiveness of the treatment and safety of diagnostic and treatment methods:

Lack of clinical manifestation of malaria;

For the prevention of infection of malaria mosquitoes In the transmission season, the patient of a one-day dose of Primakhin (0.45 mg of the base of an adult) should be heard, if, after the treatment of tropical malaria, Gametocytes are detected.

Preparations (active substances) used in the treatment

Hospitalization

Indications for hospitalization

Indications for emergency hospitalization: Tropical malaria, malaria with complications.

Information

Information

III. Organizational aspects of the implementation of the Protocol

List of protocol developers:

1) Kosherova Bakhyt Nurgalievna - Doctor of Medical Sciences, Professor RGP on PVV "Karaganda State Medical University", Vice-Rector for Clinical Work and Continuing Professional Development, Freelance Infectnessist MZSR RK

2) Duisenova Amangul Kuandikovna - Doctor of Medical Sciences, Professor, Head of the Department of Infectious and Tropical Diseases of the RGP on the PVV "Kazakh National Medical University named after S.D. Sfendiyarov"

3) Ihambaeva Ainur Nygymanovna - Medical University of Astana JSC Doctor - Clinical Pharmacologist, Assistant Department of General and Clinical Pharmacology

Indication for the lack of conflicts of interest: absent.

Reviewers:
Baheeva Dynagul Ayapbekovna, D.M., Professor, JSC "Medical University of Astana", head of the department of children's infectious diseases.

Note Protocol Review Conditions: Revision of the Protocol in 3 years and / or when new diagnostic and / or treatment methods appear with a higher level of evidence.

Attachment 1

Countries endemic by malaria

Continent, region	Country
Asia and Oceania	Afghanistan, Bangladesh, Bhutan, Vanuatu, Vietnam, India, Indonesia, Iran, Iraq, Yemen, Cambodia, PRC, Laos, Malaysia, Myanmar, Nepal, United Arab Emirates, Oman, Pakistan, Papua New Guinea, Saudi Arabia, Solomon Islands, Syria , Tajikistan, Thailand, Philippines, Sri Lanka
Africa	Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Djibouti, Egypt, Zair, Zambia, Zimbabwe, Cameroon, Cape Verde, Kenya, Congo, Côte d ' Ivoire, Comoros, Liberia, Mauritius, Mauritania, Madagascar, Malawi, Mali, Morocco, Mozambique, Namibia, Niger, Nigeria, San Tome and Principe, Swaziland, Senegal, Somalia, Sudan, Sierra Leone, Tanzania, Outland , Tsar, Chad, Equatorial Guinea, Ethiopia, Eritrea, South Africa
Central and South America	Argentina, Belize, Bolivia, Brazil, Venezuela, Haiti, Guyana, Guatemala, Guyana French, Honduras, Dominican Republic, Colombia, Costa Rica, Mexico, Nicaragua, Panama, Paraguay, Peru, Salvador, Suriname, Ecuador

Appendix 2.

Laboratory diagnostics of malaria

In the presence of clinical and epidemiological prerequisites and the negative result shows a re-study after 6-12 hours for 2 days.
It is recommended to conduct a study at the peak of temperature lift.

Preparations of blood from persons with suspicion of malaria are examined in a clinical diagnostic laboratory medical organization With confirmation of the results of the study in the territorial organization of the SanEpidservice. All positive and 10% of the total number of viewed drugs are sent for a test study into the territorial organization of the SanEpide service, and those, in turn - to the superior organization of the SanEpidservice.

2. According to emergency testimony: Fast diagnostic tests (RDT, Rapid Diagnostic Tests) using immunochemical sets (advantages - simplicity and speed of obtaining results in 5-15 minutes and do not require the use of a microscope, disadvantage - sensitivity and specificity below the microscopic method, high cost). The studied material - blood (serum / plasma).

Appendix 3.

Medicinal preparations for malaria

Doxycycline Hydrochloride, DoxycyCline (Vibramicin) - antibiotic, semi-synthetic oxytetracycline derivative. Produced by Pfizer, Khimfarmomkinat Akrikhin OJSC. Yellow crystalline powder. Slowly dissolved in water. Quickly absorbed and slowly allocated from the body. Well penetrates organs and fabrics, weakly in spinal fluid. Take after eating. Appoint adults and children over 8 years old.
Indications: Tropical chlorookhin-resistant malaria, Amebiaz, digesubiasis.
Precautions: very carefully prescribed patients with kidney and liver diseases, because Cumulation of the drug is possible.
Side effects: anorexia, nausea, vomiting, diarrhea, glossite, stomatitis, gastritis, allergic skin reactions, swelling of quinque, etc., deposition of drug in dental enamel and dentine, candidiasis.
Release form: in gelatin capsules of 50 and 100 mg.
Storage: B. List in a dry, lightweight place at room temperature.

Clindamycin (Clindamycin) The drug from the group of antibiotics - lincoosamides has a wide range of action, bacteriostatic, binds to the 50s ribosome subunit and inhibits protein synthesis in microorganisms.

Side effects: dyspeptic phenomena, esophagitis, jaundice, violation of the function of liver and kidney, hypotension, thrombophlebitis, pseudo-membrane colitis, neutropenia, eosinophilic, thrombocytopenia, allergic reactions; Maculopapulous rash, urticaria, itching.

Contraindications: Hypersensitivity, pronounced disorders of the liver and kidney function.

Release form: Capsules gelatin 150 mg.

Storage conditions: at a temperature of 15-25 ° C.

MEFLOKHIN, MEFLOQUINE (LARIAM) - 4-quinoline methanol, antiprotozoic drug, structurally close to quinine. Produced by Roche.
It is an active hemachisolocidal drug with all forms of malaria, including a tropical, resistant to chlorochin and a combination of pyrimetamine-sulfonamide. Not suitable for parenteral use, well absorbed into the gastrointestinal tract. A serious advantage is the appointment of a single dose of the drug, preferably in two receptions.
Side effects: dizziness, headache, nausea, vomiting, diarrhea, abdominal pain, anorexia, sinus bradycardia and arrhythmia, rash, skin itching, violation of coordination, blurred vision, hallucinations, convulsions, acute psychosis. The simultaneous purpose of Kinin can enhance the side effects of Mesflohin.
Contraindications: It is impossible to persons receiving β-adrenoblays, calcium antagonists, cannot be operating on airplanes, with dangerous or heavy equipment.
Release form: Tablets 250 mg of base, 8 pcs. packaged.
Storage: In well-closed containers, protected from moisture.

Primachina Diffosfat, Primachinum Diphosphate - Antiprotozoic preparation, a derivative of methoxyxinoline. Small-crystalline powder, bright yellow color, bitter taste, soluble in water.
Primahin and its analogue Rinocide are the only preparations with a strong hypnosic effect, which makes them indisposed by the radical therapy and the radical prophylactic treatment of three-day malaria with long-term incubation, also has a pronounced hametocytocidal effect on P.Falciparum genital cells. Apply during meals.
Contraindications: undesirable to prescribe pregnant, nursing mothers, as well as persons with insufficiency of glucose-6-phosphate dehydrogenases, with acute infectious diseases, during the exacerbation of rheumatism, with diseases of the blood-forming organs and kidneys, angina. It is impossible to be used simultaneously with drugs depressing blood formation.
Side effects: abdominal pain, dyspepsia, pain in the heart, methemoglobinemia, acute intravascular hemolysis with hemoglobinuria (with G6FDG deficiency).
Precautions: Do not appoint Primahin simultaneously with sulfanimamides, take into account the possible deficiency of G6FDG.
Release form: Tablets of 3 and 9 mg.
Storage: List B. in dark color banks.

Chlorohina chloride or chlorohina phosphate, (delagil, resokokhin, Malarex, Arallelen) - The most widely used antimalarial drug. Produced by the firms "Sanofi" and others.
White or white with a creamy tint crystalline powder, very bitter taste. Easily soluble in water, very little - in alcohol.
Indications: The main preparation for the treatment and chemoprophylaxis of drug sensitive tropical and all other species forms of malaria. Well absorbed into the gastrointestinal tract. Not contraindicated during pregnancy.
Contraindications: with severe heart lesions, diffuse damage to the kidneys, impaired liver function, shock-forming organs. It is impossible to patients with epilepsy and psoriasis.
Side effects: dermatitis, dizziness, headache, nausea, vomiting, ears, violation of accommodation, anorexia, abdominal pain, moderate leukopenia, reducing visual acuity, flashing in the eyes, pigment deposition in the cornea. Fast V / in Introduction can lead to a collapse.
Precautions: often carry out general blood tests and urine, follow the function of the liver, periodically - ophthalmic surveys.
Release form: Tablets of 100 and 150 mg of base, powder, ampoules of 5 ml of 5% solution.
Storage: List B, powder - in a well-closed container protected from light; Tablets and ampoules - in light-protected place.

Cinenine, Quinine (Kinina hydrochloride, quinine sulfate) - Anti-Fire Treatment. White crystalline powder, odorless, very bitter taste. Easily soluble in water (quinine hydrochloride) and alcohol. It has a hemachisolocidal action, pronounced by tropism to blood stages feeding with hemoglobin.
Indications: The preparation of the first line for the treatment of poly-resistant tropical malaria, for parenteral use in patients with intolerance to oral administration of drugs.
Side effects: noise in the ears, dizziness, vomiting, heartbeat, hand shake, insomnia. Erythema, urticaria, uterine bleeding, hemoglobinurion fever. When in / in the introduction it is possible arterial pressure or the development of cardiac arrhythmia. With a / m administration, it is possible to break sterility.
Precautions: It is impossible for idiosyncraysia to quinine.
Contraindications: Hypersensitivity, deficiency of G6FDG, cardiac decompensation, late months of pregnancy.
Forms of release: Tablets quinine hydrochloride 250 and 500 mg, chinine ampoules Dihydrochloride per 1 ml of 50% solution.
Storage: In a well-closed container, protected from light.

Rules:

1) If the vomiting appears earlier than 30 minutes after the intake of the antimalarial drug, the same dose should be replaced. If vomiting arose after 30-60 minutes. After receiving the tablets, it is additionally prescribed half the dose of this drug.

Appendix 4.

Distribution of tropical malaria resistant to antimalarial preparations

Country	The stability of K.
	Chlorhine	Meflohin
Angola	+	-
Afghanistan	+	-
Bangladesh	+	-
Benin	+	-
Bolivia	+	-
Botswana	+	-
Brazil	+	-
Burkina Faso	+	-
Burundi	+	-
Butane	+	-
Djibouti	+	-
Zaire	+	-
Zambia	+	-
Zimbabwe	+	-
India	+	-
Indonesia	+	-
Iran	+	-
Yemen	+	-
Cambodia	+	+ (in Western provinces)
Cameroon	+	-
Kenya	+	+
China	+	-
Colombia	+	-
Comoros	+	-
Côte d * Ivoire	+	-
Laos	+	-
Liberia	+	-
Mauritania	+	-
Madagascar	+	-
Malawi	+	-
Malaysia	+	-
Mali.	+	-
Myanmar (former Burma)	+	-
Mozambique	+	-
Namibia	+	-
Nepal	+	-
Niger	+	-
Nigeria	+	-
Oman	+	-
Pakistan	+	-
Papua New Guinea	+	-
Peru	+	-
Rwanda	+	-
San Tome and Principe	+	-
Saudi Arabia	+	-
Swaziland.	+	-
Senegal	+	-
Solomon islands	+	-
Somalia	+	-
Sudan	+	-
Suriname	+	-
Sierra Leone	+	-
Tajikistan	+	-
Thailand	+	+ (border with Myanmar and Cambodia regions)
Tanzania	+	-
Togo	+	-
Uganda	+	-
Philippines	+	-
French Guiana	+	-
Central African Republic	+	-
Chad	+	-
Sri Lanka	+	-
Equatorial Guinea	+	-
Eritrea	+	-
Ethiopia	+	-
South Africa	+	-

Growing resistance to antimalarial preparations is distributed by a rapid pace, which undermines efforts to combat malaria.

If the resistance to Artemisinin will receive further development And it will spread to other major geographic areas, as it happened earlier with chlorochin and sulfadoxin-pyrimetamine (SP), the consequences for the health of people can be catastrophic, since alternative antimalarial drugs will not appear in the next five years.

Appendix 5.

Prevention of malaria

Fighting of carriers is the main way to reduce the level of transmission of malaria at the level of individual communities. This is the only event that can reduce malaria transmission with very high levels Almost to zero. In the field of personal prevention of malaria, the first line of defense is the individual protection against mosquito bites.

In a wide variety of conditions, two types of carrier struggle are effective.

1. Insecticide-processed mosquito nets (OR).

The preferred OIC type for health programs for distribution are grids impregnated with insecticide long action (Sidd). WHO recommends providing coverage of all people at risk and in most places. The most efficient in terms of the cost of achieving this goal is the free provision of Sidd so that every person can sleep for Sidd every night.

2. Spraying inside the premises of the residual insecticides. Spraying of the insecticides of residual action indoors (RIORDUP) is the most effective way to quickly reduce the level of transmission of malaria. The full potential of this event is implemented under the condition that spraying is made at least 80% of homes in target areas. Spraying indoors is effective for 3-6 months, depending on the insecticide used and the type of surfaces on which spraying is made. DDT can be effective in some cases within 9-12 months.

Schemes of personal chemoprophylaxis of the country traveling to endemic on malaria, depending on the characteristics of the situation in their foci

Options of foci	Preparations	Reception schemes	Typical countries
Foci of tropical malaria without resistance to chlorohine	chlorookhin *	300 mg of base (2 tablets) weekly	Haiti, Dominican Republic, Central America North-west Panama Canal
Foci of tropical malaria with resistance to chlorohin	mEFLOKHIN *	250 mg of the foundation weekly	Tropical Africa, Brazil, Colombia, etc.
P.Falciparum Multi-Sustaine Foci	doxycycline	100 mg (1 tablet / capsule) daily	border Areas of Thailand with Cambodia and Myanmar
Foci of three-day malaria	Chlorookhin *		Turkey, Iraq, Syria, Azerbaijan
Foci of three-day and drug-sensitive tropical malaria	Chlorookhin *	300 mg of base (2 tab.) Weekly	Mexico, Central America, Haiti, Dominican Republic, Paraguay, Ar-Ghetina, Tajikistan

Attached files

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In the case of a local transmission of malaria, confirmed by the epidemiworks of the focus, during the effective contamination of mosquitoes, it is necessary to conduct a seasonal chemoprophyphylaxis of the population in the focus of degree or Tindurine 1 time per week. If in the large settlement of cases of malaria disease, the chemoprophylaxis can be carried out on a micro-frame principle. Pre-treatment of fevering single dose This drug should be carried out in cases where it is necessary to urgently weaken clinical manifestations or to warn the transfer of malaria in the focus. To prevent the late manifestations of three-day malaria after the completion of the transmission season or before the next epidemic season, the same persons should be conducted by the intelligent chemoprophylaxis of Priahin for 14 days. Chemoprophylaxis is carried out on family lists, the drug is accepted only in the presence of a medical worker. The decision on the conduct of chemoprophylaxis is adopted by the Office (territorial separation management) of Rospotrebnadzor on the subject of the Russian Federation.

Preparations used for tropical malaria chemophilate

Preparations or their combination *	Dose	Schemes
For adults	for kids	Before departure to the zone	After returning
1-4 g	5-8 L.	9-12 L.	13-14 L.
Delagil (Chlorochin)	300 mg / week.	¼	½	¾	¾	In 2 weeks	6 weeks
Delaguil (Chlorookhin) + Proganil	300 mg / week. +200 mg / week.	¼ ¼	½ ¾	¾ ½	¾ 1 dose of adult	1 time per week	1 time per week
MEFLOKHIN	250 mg	¼	½	¾	¾	For 1 week once	4 weeks 1 time in week
Doxycycline	100 mg / day	Not recommended	1 dose adult.
* - In total, the reception period should not exceed 4-6 months, drugs are contraindicated to children under 1 year. For pregnant women: Chlorookhin + Proganil - only in the first 3 months, Meflohin - from 4 months. Pregnancy is desirable in 3 months. After completion of the prevention of meflohin, 1 week after doxycycline.

Emergency Prevention Scheme Rift Valley Fever

Name of drugs	Mode of application	One-time dose, g	Multiplicity of application per day	Daily dose g	Course dose, g	Course duration, day
Virazole.	V / B.	1,0-1,5		1,0-1,5	3,0-6,0	3-4
Alphaeferon	V / M.	3 million meters		3 million meters	9-12 million meters	3 – 4
Immunoglobulin normal human for intravenous administration	V / B.	25-50 ml	1 (48-72 hours after the first use)	25-50 ml	3-10 transfusions	4-20
Ascorbic acid 5% pp	V / B.	2.0 ml		2.0 ml	10,0-14,0	5-7
Rutin	inside	0,002		0,006	0,03-0,042	5-7
DiMedrol.	V / M.	0,001		0,001	0,005-0,007	5-7

Malaria is an acute protozoic infection caused by malaria plasmodium, characterized by a cyclic recurrent course with a change in acute fevering attacks and intergreacy states, hepatosplegegaly and anemia.

Pathogens of malaria man

P.vivax - Causes 3-day malaria, is widespread in Asia, Oceania, South and Central America. P.Falciparum - The causative agent of tropical malaria is common in the same regions, and in countries of Equatorial Africa is the main pathogen. P.Malariae. - causes 4-day malaria, and R.OVALE - 3-day oval malaria, it is raised by Equatorial Africa, individual cases are recorded on Oceania Islands and in Thailand.

Malaria treatment is aimed at interrupting the red blood cell development cycle of plasmodium (schistonium) and, thus, to stop acute attacks Diseases, destroy sexual forms (gametocytes) to terminate the transfer of infection, affect the "dormant" fabric stages of the development of plasmodium in the liver to prevent remote recurrences of three-day and oval malaria. Depending on the action on one or another stage of the development of the causative agent among antimalarial drugs, schizotropic (shizontocides) is distinguished, which, in turn, are divided into hematoshizotropic, acting on erythrocyte stems, histoshizotropic, active in the tissue forms of plasmodiums in hepatocytes, and gametropic preparations, The effect on the floor forms of plasmodium.

To stop acute manifestations of malaria, gematoshizotropic preparations () are prescribed.

Table 1. Treatment of uncomplicated malaria

A drug	Application scheme		Course duration (days)	Pathogen	Resistant pathogen
	first dose	subsequent doses
Chlorochin	10 mg / kg (base)	5 mg / kg	3	P.vivax P.ovale P.Malariae.	W. P.vivax Sensitivity in New Guinea, Indonesia, Myanmar (Burma), Vanuatu
Pyrimetamine / sulfadoxin	0.075 g +. 1.5 g	--	1	P.Falciparum	Southeast Asia, Africa, South America
Quinine	10 mg / kg (base)	10 mg / kg every 8-12 C.	7-10	P.Falciparum	Moderate stability in Southeast Asia
Cine + doxycycline	10 mg / kg 1.5 mg / kg	10 mg / kg 1.5 mg / kg	10 7	P.Falciparum
MEFLOKHIN	15-25 mg / kg (in 1-2 reception)	--	1	P.Falciparum	Thailand, cambent
Galofantrin	8 mg / kg	2 receptions of 8 mg / kg after 6 h 1.6 mg / kg / day	1	P.Falciparum	Cross stability with meflohin
Artytemteer	3.2 mg / kg		7	P.Falciparum
ARTESUNAT.	4 mg / kg	2 mg / kg / day	7	P.Falciparum

For the purpose of radical cure (preventing relapses) in malaria caused by P.vivax or P.ovaleAt the end of the course of chlorochin, the Gistoshizotropic drug Primahin is used. It is used by 0.25 mg / kg / day (base) for 2 weeks. As a Gametotropic drug, Priahin is prescribed in the same dose, but within 3-5 days. Strains P.vivaxResistant to Primahin (the so-called strains of the Cesson type) are found on the islands of the Pacific Ocean and in the countries of Southeast Asia. In these cases, one of the recommended schemes is to receive a primahin at a dose of 0.25 mg / kg / day for 3 weeks. When using Primahin, it is possible to develop intravascular hemolysis in people with a deficiency of glucose-6-phosphate dehydrogenase of red blood cells. In such patients, if necessary, an alternative treatment regimen can be used - 0.75 mg / kg / day once a week for 2 months.

Due to the extremely wide distribution of chlorochine resistant and some other antimalarial drugs P.Falciparum, in almost all endemic zones in cases of non-heavy flow of tropical malaria and the absence of prognostically adverse signs of selection drugs are MEFLOKHIN, artemisinin derivatives (Artemeter, Artesunate) or halofintrine.

Often in patients during the reception of oral antimalarial preparations there are vomiting. In such cases, if vomiting developed less than 30 minutes after receiving the drug, the same dose re-apply. If 30-60 minutes passed after the reception, then the patient takes another half of the dose of this LAN.

With severe and complicated malaria Patients should be hospitalized in the Orit. These etiotropic therapy is carried out by parenteral administration of drugs.

The selection for the treatment of severe tropical malaria remains the chinin, which is used in / in a dose of 20 mg / kg / day in 2-3 administration at intervals of 8-12 hours. The daily dose for an adult should not exceed 2.0 g. To avoid complications The obligatory rule is significant dilution (in 500 ml of 5% ral glucose or 0.9% sodium chloride) and very slow administration, within 2-4 hours. B / in the introduction of quinine is carried out before the patient output from severe state , after which the chemotherapy course is completed by oral application quinine.

There are two schemes for the treatment of severe tropical malaria Rinin:

• 1-M - Provides the initial introduction of the impact dose of the drug, providing its high concentration in the blood - 15-20 mg / kg of bases are introduced into / in for 4 hours, further apply the maintenance doses - 7-10 mg / kg every 8-12 hours Prior to the possibility of transferring the patient to the oral medication.
• 2nd - 7-10 mg / kg of base are introduced in / in for 30 minutes, after which another 10 mg / kg is introduced for 4 hours. In the following days, the introduction of the drug is continued at the rate of 7-10 mg / kg every 8 hours to the possibility of transferring to oral administration. Before appointing these schemes, it is necessary to make sure that over the past day, the patient did not take the chinin, quinidine or mesflohin.

Since the treatment with one rinine alone does not provide radical malaria casing (the chinin is preserved in the blood in only a few hours; its long-term application often leads to the development of HP), after improving the patient's condition, the chlorochin treatment is carried out. And if there is a suspicion of chlorochinosity, then pyrimetamine / sulfadoxin, mesflohin, tetracycline or doxycycline are prescribed.

Due to the fact that in some regions, in particular in Southeast Asia, there is resistance P.Falciparum And to quinine, there, with severe tropical malaria, the derivatives of Artemisinin are used for parenteral administration (Arteteter, Artesunate) within 3-5 days until the possibility of transition to oral administration of the antimalarial preparation.

Therapy of renal failure, acute hemolysis with anemia and shock, edema of light and other complications of tropical malaria are carried out against the background of antimalarial therapy on generally accepted principles. When developing hemoglobinorial fever, it is necessary to cancel the chinin or other drugs that caused the intravascular hemolysis of the erythrocytes, and replace with another hematoshizotropic agent. Under cerebral malaria, it is recommended to refrain from the use of glucocorticoids, NSAIDs, heparin, adrenaline, low molecular weight dextran, cyclosporine A, hyperbaric oxygenation. Under the edema of the lungs, due to excess hydration, the infusion therapy should be discontinued.

Features of malaria treatment during pregnancy

The preparation of choice for the treatment of malaria in pregnant women is the chinin, acting on most of the plasma strains, and with parenteral administration, has a fairly rapid effect on the causative agent. When used in pregnant women, it is not recommended to use chinin at a dose of more than 1.0 g / day. For the treatment of uncomplicated tropical malaria in pregnant women, with the exception of the I trimester, you can use MEFLOKHIN.

Chemoprophylaxis of malaria

Insension individual (personal), group and mass chemoprophylaxis. In terms of holding - short-term (during their stay in the focus of malaria), seasonal (the entire period of malaria transmission) and the interseasonal (all-season).

Personal chemoprophylaxis of malaria is carried out by all people leaving in endemic foci. Depending on the intensity of transmission in a particular focus and sensitivity of malaria plasmodium, currently for personal chemoprophylaxis is used by Meflohin, chlorookhin (sometimes in combination with proganil) and doxycycline ().

Table 2. Personal chemoprophylaxis of malaria

A drug	Dosing mode		Foci in which the use is recommended
	adults	children
MEFLOKHIN	0.25 g / week	body weight 15-45 kg - 5 mg / kg / week (with weight less than 15 kg no applied)	Foci of tropical malaria with stability P.Falciparum To chlorohine
Chlorochin +. progan	0.3 g / week 0.2 g / day	5 mg / kg / week 3 mg / kg / day	Foci of 3-day and tropical malaria without resistance to chlorohine
Chlorochin	0.3 g / week	5 mg / kg / week	Foci of 3-day malaria
Doxycycline	0.1 g / day	Over 8 years old - 1.5 mg / kg / day (up to 8 years not applied)	Foci with polyzerism P.Falciparum

It should be borne in mind that there are no absolutely effective and safe antimalarial preparations. To achieve the necessary concentration of the drug in the blood by the time of infection and identifying possible HP, it is recommended to begin to take it in advance: MEFLOKHIN - for 2 weeks, Chlorochin - for 1 week, prison and doxycycline - 1 day before departure to the endemic country in malaria. LS take over the entire period of stay in the focus, but not more than 6 months. With poor tolerability, drugs should be replaced by another, without stopping prevention. After departure from the endemic LS country, it continues to take another 4 weeks in the same dose.

The chemoprophylaxis of malaria in pregnant women in the first trimester is carried out by chlorochin in combination with proganille, replacing their subsequent two trimesters with meflohin.

Amebiaz

Amebiaz - infection caused Entamoeeba Histolytica.characterized by the ulcerative damage to the colon, the inclination to the chronic recurrent flow and the possibility of the development of extractuage complications in the form of liver abscesses and other organs.

Selection of antimicrobial drugs

Preparations of choice For the treatment of invasive amebiasis are tissue amebecides from a group of nitroimidazoles: Metronidazole, Tinidazole, ornidazole, secandases. They are used to treat both intestinal amebiasis and abscesses of any localization. Nitroimidazoles are well absorbed into the gastrointestinal tract and, as a rule, they are used inside. The introduction of metronidazole is used in severe patients with the impossibility of oral administration.

Alternative preparations. For the treatment of invasive anmebiasis and, above all, the liver abscesses can also use element hydrochloride (abroad dehydroeomethine dihydrochloride) and chlorochin. Due to the possibility of the development of heavy HP, primarily the cardiotoxic effect, element and dehydroeomethin are reserve preparations that are recommended to be prescribed to patients with extensive abscesses, as well as in the ineffectiveness of nitroimidazoles. Chloroquine is used in combination with dehydroeomethin in the treatment of amoebic liver abscesses.

For the treatment of non-invasive amebiasis (asymptomatic carriers), transluency Amebecides are used - famide, Dilosanide Furoate, Paromomycin (). In addition, they are recommended to be applied after the completion of the course of treatment with tissue amebecides for the elimination of Ameb, remaining in the intestine, and in order to prevent relapses.

Table 3. Amebiaz Treatment

A drug	Dosing mode
	intestinal Amebiaz	extrakest Amebiaz (liver abscess and other organs)	Non-invasive Amebiaz (carriage)
Metronidazole.		30 mg / kg / day in 3 reception within 8-10 days
Tinidazole.
Ornidazole.	30 mg / kg every 24 hours for 3 days	30 mg / kg 1 time per day for 5-10 days
SHINDASOL.	30 mg / kg every 24 hours for 3 days	30 mg / kg every 24 hours for 5-10 days
Chlorochin		0.6 g / cout (base) for 2 days, more than 0.3 g / day for 2-3 weeks
This famed			20 mg / kg / day in 2 reception within 5-7 days
Paromomycin			25-30 mg / kg / day in 3 reception within 7-10 days
Diloksanide Furoate			0.5 g every 6-8 hours for 10 days
Emetine Dehydroemethe	1 mg / kg / day (Emetine - no more than 60 mg / day, dehydroeomethine - no more than 90 mg / day)	1 mg / kg / day (Emetine - no more than 60 mg / day, dehydroeomethin - no more than 90 mg)

Giardiasis

Giardiosis (hyardiosis) - Protozoy infection caused Giardia Lambliaflowing with intestinal functional disorders, but more often as asymptomatic carriage.

Selection of antimicrobial drugs

Selection preparations: Metronidazole adults at 0.25 g every 8 h (during meals), children - 15 mg / kg / day in 3 reception. The duration of the course is 5-7 days. Another reception mode in adults: 2.0 g of one reception within 3 days or 0.5 g / day for 10 days.

Alternative drug: Tinidazole - 2.0 g once.

Cryptosporidiasis

Cryptosporidiosis - infection caused by the simplest family Cryptosporididae.flowing with the lesion of the mucous membranes of the digestive system accompanied by diarrhea. In people with normal immunity, the disease is completed with self-esteem, while in patients with immunodeficiency develop profuse diarrhea, dehydration, malaborbization syndrome, body weight loss.

Selection of antimicrobial drugs

In patients without impairment of immunity, only pathogenetic therapy is carried out, primarily for the correction of water-electrolyte disorders. Standard glucose salts are used for oral administration and solutions for in / in administration.

In patients with AIDS, it is necessary to use the entire complex of drugs, including antiretroviral. Conduct oral and in / in rehydration, as necessary, use parenteral nutrition.

Effective etiotropic means for the treatment of cryptosporidiosis is not.

Selection preparations: Paromomycin (monomocin) inside 0.5 g every 6 hours for 2 weeks and more. When recurring, the course of therapy is repeated.

Alternative preparations: In individual patients, some positive effect was obtained with the use of macrolides (spiramycin, azithromycin, clarithromycin, roxitromycin).

Toxoplasmosis

Toxoplasmosis - infection caused by the simplest TOXOPLASMA GONDII.characterized by a large variety of flow options and polymorphism of clinical manifestations. In most cases, as a result of infection with toxoplasms, asymptomatic carriage develops. The most severe forms of lesions of organs and systems are developing in patients with immunodeficiency (AIDS, etc.).

Selection of antimicrobial drugs

Treatment is most effectively in the acute phase of the disease. In chronic toxoplasmosis, efficiency decreases, since the drugs used weakly affect the endozite (bradyzoids), which are in tissue cysts. Cystrithromycin with sulfonamides, also under the fitting of folic acid. Therapy is carried out within a few months.

Leishmaniosis

Leisimanias are a group of transmissive protozoa infections of man and animals transmitted by mosquitoes; Characterized by limited lesions of the skin and mucous membranes with ulceration and scarring (skin leishmaniasis) or damage to internal organs, fever, splenomegaly, anemia, leukopenia (visceral leishmaniasis).

Basic pathogens

Old light skin leschemaniosis cause Leishmania Tropica. (L.Tropica minor), L.Major. (L.Tropica Major.), L.aethiopica.; New light - L.Mexicana, L.Braziliensis, L.Peruviana.

The causative agent of visceral leishmaniosis is L.Donovani.whose subspecies ( L.DONOVANI DONOVANI, L.DONOVANI CHAGASI) Call various clinical and epidemiological options for infection.

Selection of antimicrobial drugs

Selection preparations: For the specific treatment of skin leschemaniosis caused L.Tropica, L.Major, L.Mexicana, L.Peruviana - Meglumin Antimonat (compound 5-valence antimony). Treatment is carried out by local administration of the drug at the concentration of Sb 85 mg / ml: tightly infiltrate the area of \u200b\u200bthe lesion, produce 1-3 injections with an interval of 1-2 days.

The drug for the treatment of patients with visceral leishmaniasis is a meglumin antimonate, which is used in the form of an injection injectations at the rate of 20 mg of SB per 1 kg of body weight per day, only 10-15 injections; The duration of the course of treatment varies in different countries.