02 September 2010
By Umesh Isalkar
Plasmodium Strains Have Not Yet Developed Resistance To ACT Tablet
The chloroquin tablet, which has become synonymous with the treatment of malaria, has been replaced with a more effective anti–malarial drug: ACT.
As per the latest guidelines issued by the Union government under the National Drug Policy on Malaria 2010, any patient with falciparum malaria will now be treated with ACT (Artesunate combination therapy). Artesunate is currently the only medicine that has not yet been resisted by malaria plasmodium strains.
"The Central government has already issued guidelines to all states with respect to changes in the treatment method. It will soon be implemented across the state. henceforth, all patients of malaria caused by falciparum strain will be treated with artesunate tablets. However, malaria caused by vivax strain will continue to be treated with chloroquin and primaquin," said V D Khanande, joint director (malaria), state health department.
A demand for Artesunate tablets has been placed with the Union government. But, till then patients with falciaprum malaria will be treated with the existing anti–malarial drugs, Khanande said.
Malaria is a major health concern in the country with appriximately 1.5 million laboratory confirmed cases reported annually. Of these, 50 per cent cases are due to falciparum. One of the reasons attributed to rise in proportion of falciparum cases is resistance to chloroquin which was used for a long time as a first line of treatment. Falciparum malaria infections are known to lead to severe malaria if timely treatment with effective drugs is not administered, says the draft of the National Drug Policy on Malaria 2010 prepared by Directorate of National Vector Borne Disease Control Programme, Union Ministry of Health and Family Welfare.
The state has reported 47,200 malaria cases between April and July this year. Of them, Mumbai alone has 29,531 cases. As many as 41 people have died during the same period. Of them, Mumbai has 30 deaths. "Of the total cases, over 4,000 people have been diagnosed with malaria caused by falciparum strain during April and July this year," said state entomologist B R Mane.
"The National Drug Policy on malaria was first formulated in 1982 and had subsequently been reviewed and revised periodically. The present National Drug Policy on Malaria 2010 has been drafted keeping in view the availability of more effective antimalaria drugs and drug resistance status in the country," said Mane.
Earlier, the ACT was given only to people who developed resistance to existing drugs. Dhanora block in Gadchiroli village was earlier treated with ACT, as it was found to be a pocket where people have developed resistance to the existing drugs. The newer guidelines prescribes ACT to all patients of falciparum malaria.
Effective treatment of malaria under the National Drug Policy aims at
- Providing complete cure (clinical and parasitological)
- Prevention of progression of uncomplicated malaria into severe malaria, thereby reducing mortality
- Prevention of relapses through radical treatment
- Interruption of transmission by use of gametocytocidal drugs
- Preventing development of drug resistance
- Malaria caused by falciparum strain of malaria should be treated with ACT (artesunate for three days + Sulphadoxine–Pyrimethamine 1 day). To be accompanied by a single dose primaquin preferably on day 2.
- Malaria caused by vivax strain of malaria should be treated with chloroquin for three days and primaquine for 14 days. Primaquin is used to prevent relapse but is contraindicated in pregnant women, infants etc.
- Presumptive treatment with chloroquin is no more recommended
- Pregnant women with uncomplicated faliciparum should be treated with Quinine in their first trimester and with ACT if they are in second and third trimester.
- Primaquin is contraindicated in pregnant woman
- Suspected malaria cases will be treated with full course of Chloroquin till the results of microscopy are received
- Chemoprophylaxis should be administered only in select groups in high falciparum endemic areas. Use of personal protection measures including Insecticide Treated bed Nets (ITN) / Long Lasting Insecticidal Nets (LLIN) should be encouraged for pregnant women and other vulnerable population including travellers.