anti malarials

8/4/2019 Anti Malarials

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Anti-malarials


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Malaria

Uncomplicated malaria Severe malaria

Falciparum malariaVivax malaria Falciparum malaria

Negligence CQ resistance

Quinine Inj.Artesunate Inj.

Arteether Inj.Followed byQuinine tab.Arte + Meflo

Arte + Sulfa & Pyri

Chloroquine(Oral)

Amodiaquine

Artesunate oral,

Artemether oral,Artemether + LumeArtesunate + MefloArte + Sulfa + Pyri

Sulfa + Pyri

Vivax malaria

CQ Inj.

Artesunate InjArteether InjCQ tab.

Artesunate tabSulfa + Pyri

Artesunate InjArteether Inj.

Followed byArte + MefloArte + Sulfa

& Pyri


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OpportunitiesArteplus CD/Falcigo/Plus

CQ in vivax

Malaria

Arte-CD

SP in CQresistantmalaria

Arte-CD

CQ in severevivax malaria

Falcigo/plus

SP in UC

Falci.Malaria

Arte/Fal plus

Aremetherin UC falci.

MalariaArte-CD

Falcigo

plus

Arteether inSevere

MalariaFalcigo

Falcigo

plus

Quinine insevere

malariaFalcigo

Falcigo plus


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Condition

Region is endemic for malaria.

Chloroquine resistant strains of P.vivaxand P.falciparum are seen in the region.

More cases of malaria were due tofalciparum.

Many cases were found to be havingmixed infection


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Situation 1-

CQ in vivax malaria

Patient concern:-

Patient is having high grade fever withmoderate chills.

Feeling of weakness

Loss of appetite


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Therapeutic needs

Faster fever clearance time

Faster parasite clearance time

To prevent the infection from becomingsevere.


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Focus point

To normalize the patient as early aspossible.

Effective treatment of mixed infection dueto vivax/falciparum.

Control the infection so that it does notbecomes severe.


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Call objective

To convert Chloroquine Rxer to Arteplus/CD in vivax/mixed malaria.


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Need identification

Dr. what are the major challenges you face whiletreating malaria ?

How difficult it is to find out the causative

pathogen of malaria when the patient mighthave already taken some treatment ?

In such cases for better treatment outcome, areyou looking for a drug which can treat both CQresistant vivax/mixed malaria effectively ?


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Benefit presentation

Dr. this article was published in Korean Journal of

Parasitology, 2007.This study was conducted on 100

patients suffering from malaria. The patients were given

Chloroquine and AL.

Conclusion:- The combination of AL was well tolerated

by all the patients and was recommended over CQ when

the possibility of the mixed infection can not be ruled out

for better treatment outcome.


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Feedback

Dr. looking at the benefits, do you thinkthat Arteplus CD is a better treatmentchoice where possibility of the mixed

infection can not be ruled out as comparedwith CQ ?


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Possible objection

CQ is more cost effective than AL?

Dr. I appreciate your concern for thepatients pocket but if you look at the costof lab test and the discomfort which thepatient has to undergo, you will find thatArteplus is more economical than CQ.


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Commitment

Dr. for better treatment outcome inmalaria, where there are chances of mixedinfection please recommend Arteplus/CD.


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Condition

Region is endemic for malaria.

Chloroquine resistant strains of P.vivaxand P.falciparum are seen in the region.

More cases of malaria were due tofalciparum.

Prevailing sulphur drug sensitivity in theregion


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Situation-2Sulfa + Pyri in CQ resistant vivax &

uncomplicated falciparum malaria.

Patient concern :-

Patientis having high grade fever withmoderate chills.

Rigors along with vomiting and malaise

Feeling of weakness ,loss of appetite


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Therapeutic needs

Instant relief from fever and rigors

Prevention of recrudescence.

To prevent the infection from becomingsevere


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Focus point

To provide relief from fever and othersymptoms of malaria.

To prevent recrudescence of the infectionin falciparum malaria.


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Call objective

To convert Sulfadoxine - PyrimethamineRxer to Arteplus/ CD in CQ resistant vivaxand uncomplicated falciparum malaria.


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Need identification

How frequently do you come across CQresistant malaria cases?

What is your drug of choice in suchcases?

Are you looking for a drug which can beused empirically for CQ resistant as wellas uncomplicated falciparum malaria?


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Dr. this article was published inParassitolgia 2004. In this article WHOhas recommended the use of AL in all the

countries experiencing resistance toconventional therapies like CQ orsulfadoxine/pyrimethamine.


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Dr. this article was published in Americanjournal of tropical hygiene,2007. Thisstudy was conducted on 99 Nepalese

patients with uncomplicated falciparummalaria.

Conclusion :- AL was found to be more

effective than SP for uncomplicatedFalciparum malaria.


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Feedback

What is your opinion regarding the use ofArteplus /CD in CQ resistant oruncomplicated falciparum malaria cases?


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Commitment

Dr. in coming 5 cases of CQ resistant anduncomplicated malaria cases, pleaserecommend Arteplus /CD.


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Condition

Drs using plain artemisinin compound in

the treatment of uncomplicated falciparummalaria.

Incidences of resistance against CQ andother antimalarials are on a rise.


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Situation 3

Artemether tab in uncomplicated

Falciparum malaria.

Patient concern:-

Patient is having high grade fever withmoderate chills.

Rigors along with vomiting and malaise

Feeling of weakness Loss of appetite


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Therapeutic needs

To reduce FCT & PCT

To prevent recrudescence of the infection

Prevention of the emergence of theresistance


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Focus point

To provide relief from fever and othersymptoms of malaria.

To prevent recrudescence of the infectionin falciparum malaria.

To prevent emergence of resistanceagainst other antimalarials.


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Call objective

To convert plain artemether Rxer toArteplus / CD or Falcigo plus inuncomplicated falciparum malaria.


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Need identification

What is your line of treatment in Uncomplicatedfalciparum malaria ?

How frequently do you see the infection

reappearance in such cases even after thetreatment with plain artemisinin compound?

In such cases are you looking for a drug whichwill not only help in preventing recrudescencebut will also reduce the likelihood of emergenceof resistance against other antimalarials?


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Dr. this study was published in Expertopinion on investigational drugs, 2000. Itsuggests that Artemisinin compounds like

Artemetheror Artesunateshould becombined with long acting antimalarialslike Lumefantrineor Mefloquine to prevent

recrudescence, to improve complianceand to prevent progression of resistanceagainst antimalarials.


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Feedback

How well do you think that Arteplus /CDorFalcigo pluscan help you in preventing therecrudescence, the emergence of

resistance and faster resolution ofsymptoms in uncomplicated falciparummalaria ?


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Commitment

Dr. In your forthcoming patients sufferingfrom uncomplicated falciparum malariadepend on Arteplus /CD for the prevention

of recrudescence, emergence ofresistance and faster resolution ofsymptoms.


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Condition

Endemic region for malaria

Resistant strains of vivax and falciparumare common in the region.

Several deaths were reported due tomalaria


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Situation-5Arteether /Artemether Inj.

In Severe malaria

Patient is having high grade fever with

chills. Severe headache and fatigue

Respiratory distress.

Jaundice Unconscious


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Therapeutic needs

Save the life of the patient.

To prevent other complications.

Faster clearance of the parasite from theblood.

To maintain high and sustainedconcentration of the drug in the blood toprevent recrudescence and to preventresistance development.


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Focus point

To save the life of the patient by havingprofound (fast and long) action of the drug.

To prevent further complications like organdamage.


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Call objective

To convert plain artemether /arteetherRxer to Falcigo Inj. in severe malaria.


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Need identification

What are the objectives of treatment insevere falciparum malaria ?

Which are the important parameters youare looking in for while Rxing a drug insuch cases ?

How important is the quick absorption and

safety of the drug in such situations?


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This article was published in New Englandjournal of medicine, 2008. This articleclearly states that the efficacy of the fat

soluble artemisinin compounds i.e.arteether & artemether in severe malaria islimited due to its varied absorption (they

are given IM). Artesunate is having morereliable pharmacokinetic profile as it iswater soluble(given IV).


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Dr. the same study speaks about thesafety profile of AS as fat solubleartemisinins were found to be more

neurotoxic as compared to AS.

AS dosage need not be changed inhepatic and renal failure cases.

No drug interaction is seen so far with AS.


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Feedback

How well do you think that Falcigo canhelp you in saving the life and preventingfurther complications in severe falciparum

malaria ?


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Commitment

Dr. In your forthcoming patients sufferingfrom severe malaria, depend on Falcigoinj. & tab for saving the life and preventing

further complications.


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Condition

Endemic region for malaria.

Many deaths has happened due to malaria

Mostly P.falciparum was seen to beresponsible for causing malaria.

MDR strains of falciparum are common inthe region.


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Situation-6Quinine Inj. In Severe malaria

High grade fever.

Severe headache and fatigue Respiratory distress/ Dyspnea.

Jaundice

Unconscious


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Focus point

To save the life of the patient

To prevent further complications like organdamage.


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Call objective

To convert plain Quinine Rxer to FalcigoInj. in severe malaria.


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Need identification

What are the objectives of treatment insevere falciparum malaria ?

Which are the important parameters youare looking in for while Rxing a drug insuch cases ?

How important is the risk reduction of

death and safety of the drug in suchsituations?


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This article was published in New Englandjournal of medicine, 2008. This articleclearly states that risk reduction of death

was 34.7% more with AS as comparedwith Quinine.

Artesunate was found to be having leastside effects unlike Quinine havinghypoglycemia, visual disturbances andtinnitus as common one.


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Feedback

How well do you think that Falcigo canhelp you in saving the life and preventingfurther complications in severe falciparum

malaria ?


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Commitment

Dr. In your forthcoming patients sufferingfrom severe malaria, depend on Falcigoinj. & tab for saving the life and preventing

further complications.

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