Anti–malarial drugs are used effectively to prevent morbidity and mortality from the disease. In many cases, the doctor will not wait until the results of a peripheral blood smear are known. Sometimes, repeated smears may have to be taken as the parasites are released occasionally in the blood. This form of treatment is called presumptive treatment. In presumptive treatment all fever cases are assumed to be due to malaria.

The age wise dosage of chloroquine for presumptive treatment

Age Group	mg base	No. of Tablets
<1 1–4 5–8 9–14 15 and above	75 150 300 450 600	1/2 1 2 3 4

Presumptive treatment is to be given to people of all age groups. Even pregnant women in any month of pregnancy or during the pospartum period should receive presumptive treatment. Cases of malaria caused by Falciparum pose a different challenge as they frequently demonstrate resistance to the action of anti–malarial drugs. The strategy in areas where the incidence of resistance to the action of drugs is high is as follows:

Presumptive Treatment (Adult Dose)

Active Case Detection (ACD), Drug Distribution Center (DDC), Fever Treatment Depots (FTD)	Passive Case Detection (PCD)
Amodiaquine. 600 mg.	Sulphalene 1000 mg plus. Pyrimethamine 50 mg.

Radical treatment
If the blood smear is positive for the malaria parasite, the surveillance worker should return to the patient and administer ‘radical treatment’ for malaria. It is to ensure a complete cure from malaria and prevention of a possible relapse.

Age in years	Tablet Chloroquine (150 mg base)		Tablet Primaquine (2.5. mg base)
	mg base	No. of Tablets	mg base	No of Tablets
	– 150 300 450 600	– 1 2 3 4	– 2.5 5.0 10.0 15.0	– 1 2 4 6

Radical Treatment of P.falciparum
If the load of malaria positive cases is very high in an area, P.falciparum cases should be given single dose radical treatment on a priority basis. The adult dose is 600 mg chloroquine and 45 mg primaquine. This dose is suitably adjusted for other age groups. Infants and pregnant women are not to be given primaquine.
Radical treatment for P.falciparum cases in areas with resistant strain of P.falciparum: The radical treatment for chloroquine resistant strains of P.falciparum as per revised drug policy is as follows: Sulphalene 1000 mg: Single dose
+
Pyrimethamine 50 mg Thereafter, Primaquine 45 mg: Single dose

Side–effects of the drugs
Chloroquin: Causes nausea, vomiting, blurring of vision and headaches may occur, but they are mild and transient. Eye toxicity has been reported, particularly to the retina but only in persons exposed to large cumulative doses over many years.

Malaria Prophylaxis
Chemoprophylaxis is recommended for persons traveling to areas where malaria is widely prevalent. It is also recommended for international travelers traveling to areas of the world where malaria is prevalent.

Chemoprophylaxis is not a substitute for protection measures against mosquitoes such as using curtains or mosquito repellants. Chemoprophylaxis should begin a week before arrival in the “Malarious” area and continued for at least four weeks or preferably six weeks after leaving such an area.

Drugs Generic Name	Adult Dose For Prophylaxis
Chloroquine Proguanil Mefloquine Doxycycline	300 mg (base) = 3 tablets of 100 mg or 2 tablets of 150 mg once a week, on the same day each week. 200 mg = 2 tablets once a day. 250 mg = 1 tablet once a week, on the same day each week. 100 mg = 1 capsule once a day.