<prompt> According to the new WHO 2013 malaria treatment guidelines, which of the following statements is true?No ACT in falciparum malariaPresumptive treatment with chloroquine should be givenPrimaquine is contraindicated in infants and pregnant womenPrimaquine is to be given for 7 days in falciparum malaria  <response>: Ans. c. Primaquine is contraindicated in infants and pregnant women Ref: Harrison 19e p1383; DocDiagnosis-Treatment-Malaria-2013 .pdfPrimaquine is contraindicated during pregnancy and in lactation unless the infant being breast-fed has a documented normal G6PD level.Primaquine is contraindicated in persons with G6PD deficiency. It is also contraindicated during pregnancy and in lactation unless the infant being breast-fed has a documented normal G6PD level -- Harrison 19e p1383.Primaquine is used to prevent relapse but is contraindicated in pregnant women, infants and individuals with G6PD deficiency: - stylefont-size: 1.04761904761905em; font-family: Times New Roman, Times, serif. inDocDiagnosis-Treatment-Malaria-2013.pdfP. falciparum cases should be treated with ACT Ariesunate 3 days Sulfadoxine Pyrimethamine 1 day. This is to be accompanied by single dose primaquine preferably on day 2. -- http: nvbdcp.gov.inDocDiagnosis-Treatment- Malaria-2013.pdfIn cases where parasitological diagnosis is not possible due to non-availability of either timely microscopy or RdT suspected malaria cases will be treated with full course of chloroquine. till the results of microscopy are received. Once the parasitological diagnosis is available, appropriate treatment as per the species, is to be administered. Presumptive treatment with chloroquine is no more recommended. -- stylefont-size: 1.04761904761905em; font-family: Times New Roman, Times, serif. PdfTreatment of Uncomplicated MalariaIt is stressed that all fever cases should be suspected of malaria after ruling out other common causes and should be investigated for confirmation of malaria by Microscopy or Rapid Diagnostic Kit RdK so as to ensure treatment with full therapeutic dose with appropriate drug to all confirmed cases.The malaria case management is very important for preventive serious cases and death due to malaria. So, the private healthcare providers should also follow the common National Guidelines for treatment of malaria as per the Drug Policy 2013.P. vivax cases should be treated with chloroquine for 3 days Primaquine for 14 daysQ.Primaquine is used to prevent relapse but is contraindicated in pregnant women, infants and individuals with G6PD deficiencyQ.Note: Patients should be instructed to report back in case of hematuria or high colored urine cyanosis or blue coloration of lips and Primaquine should be stopped in such cases. Care should he taken in patients with anemiaQ.P. falciparum cases should be treated with ACT Artesunate 3 days Sulfadoxine Pyrimethamine 1 day. This is to be accompanied by single dose primaquine preferably on day 2Q.However, considering the reports of resistance to partner drug SP in North-eastern States, the Technical Advisory Committee has recommended to use the Co-formulated tablet of Artemether 20 mg--Lumefantrine 120 mg ACT- AL as per the age-specific dose schedule for the treatment of Pf cases in North Eastern States not recommended during the first trimester of pregnancy and for children weighing 5 kg.Production and sale of Artemisinin monotherapy has been banned in IndiaQ.Pregnant women with uncomplicated P. falciparum should be treated as follows:1st Trimester: Quinine2nd 3rd Trimester: ACTNote: Primaquine is contraindicated in pregnant womanQ.In cases where parasitological diagnosis is not possible due to non-availability of either timely microscopy or RdT, suspected malaria cases will be treated with full course of chloroquine, till the results of microscopy are received. Once the parasitological diagnosis is available, appropriate treatment as per the species, is to be administered.Presumptive treatment with chloroquine is no more recommendedQ.Resistance should be suspected if in spite of full treatment with no history of vomiting, diarrhea, patient does not respond within 72 hours, clinically and parasitologicallySuch cases not responding to ACT, should be treated with oral quinine with TetracyclineDoxycvcline. These instances should be reported to concerned District MalariaState Malaria GfficerROHFW for initiation of therapeutic efficacy studies.Treatment of Severe Malaria Severe malaria is an emergency and treatment should be given as per severity associated complications, which can be best decided by the treating physicians.Before admitting or referring patients, the attending doctor or health worker, whoever is able to do it, should do RdT and take blood smear; give a parenteral dose of artemisinin derivative or quinine in suspected cerebral malaria cases and send case sheet, details of treatment history and blood slide with patient.Parenteral artemisinin derivatives or quinine should be used irrespective of chloroquine resistance status of the area with one of the following options:Chemotherapy of severe and complicated malaria.Initial parenteral treatment for at least 48 hours with one of following four options:Quinine: 20 mg quinine saltkg body weight on admission IV infusion or divided IM injection followed by maintenance dose of 10 mgkg 8 hourly; infusion rate should not exceed 5 mg kg per hour. Loading dose of 20 mgkg should not be given, if the patient has already received quinine .Artesunate: 2.4 mgkg IV or IM given on admission time 0, then at 12 h and 24 h, then once a day or Artemether: 3.2 mgkg IM given on admission then 1.6 mgkg per day or Arteether: 150 mg daily IM for 3 days in adults only not recommended for children.Follow-up treatment, when patient can take oral medication following parenteral treatment.Quinine 10 mgkg three times a day with doxvcycline 100 mg once a day or clindamycin in pregnant women and children under 8 years of age to complete the 7 days of treatment.After parenteral artemisinin therapy, patients will receive a full course of area-specific oral ACT for 3 days.Those patients who received parenteral quinine therapy should receive oral quinine 10 mgkg body weight three times a day for 7 days including the days when parenteral quinine was administered plus doxvcycline 3 mgkg body weight once a day or clindamycin 10 mgkg body weight 12-hourly for 7 days Doxvcycline is contraindicated in pregnant women and children under 8 years of age or area-specific ACT as described.Note: Pregnant women with severe malaria in any trimester can be treated with artemisinin derivatives, which, in contrast to quinine, do not risk aggravating hypoglycemia. The parenteral treatment should be given for minimum of 48 hours. Once the patient can take oral therapy, give: Quinine 10 mg,kg three times a day with doxycyciine 100 mg once a day or clindamycin in pregnant women and children under 8 years of age, to complete 7 days of treatment, in patients started on parenteral quinine. Full course of ACT to patients started on artemisinin derivatives.Use of mefloquine should be avoided in cerebral malaria due to neuropsychiatric complications associated with it. 