Anti Malarials 5d6s3q

Anti-malarials

Malaria Uncomplicated malaria

Vivax malaria

Falciparum malaria

Severe malaria

Vivax malaria

Negligence

Chloroquine (Oral) Amodiaquine

Falciparum malaria

CQ resistance

Quinine Inj. Artesunate Inj Artesunate oral, CQ Inj. Artesunate Inj. Arteether Inj. Artemether oral, Artesunate Inj Arteether Inj. Followed by Artemether + Lume Arteether Inj Followed by Arte + Meflo Artesunate + Meflo CQ tab. Quinine tab. Arte + Sulfa Arte + Sulfa + Pyri Artesunate tab Arte + Meflo & Pyri Sulfa + Pyri Sulfa + Pyri Arte + Sulfa & Pyri

Opportunities – Arteplus CD/Falcigo/Plus CQ in vivax SP in CQ resistant Malaria malaria Arte-CD Arte-CD

CQ in severe SP in UC vivax malaria Falci. Falcigo/plus Malaria Arte/Fal plus

Aremether in UC falci. Malaria Arte-CD Falcigo plus

Quinine in severe malaria Falcigo Falcigo plus

Arteether in Severe Malaria Falcigo Falcigo plus

Condition • Region is endemic for malaria. • Chloroquine resistant strains of P.vivax and P.falciparum are seen in the region. • More cases of malaria were due to falciparum. • Many cases were found to be having mixed infection

Situation 1CQ in vivax malaria Patient concern :• Patient is having high grade fever with moderate chills. • Feeling of weakness • Loss of appetite

Therapeutic needs • Faster fever clearance time • Faster parasite clearance time • To prevent the infection from becoming severe.

Focus point • To normalize the patient as early as possible. • Effective treatment of mixed infection due to vivax/falciparum. • Control the infection so that it does not becomes severe.

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

Need identification • Dr. what are the major challenges you face while treating malaria ? • How difficult it is to find out the causative pathogen of malaria when the patient might have already taken some treatment ? • In such cases for better treatment outcome, are you looking for a drug which can treat both CQ resistant vivax/mixed malaria effectively ?

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.

• Dr. looking at the benefits, do you think that Arteplus CD is a better treatment choice where possibility of the mixed infection can not be ruled out as compared with CQ ?

Possible objection • CQ is more cost effective than AL? • Dr. I appreciate your concern for the patients pocket but if you look at the cost of lab test and the discomfort which the patient has to undergo, you will find that Arteplus is more economical than CQ.

Commitment • Dr. for better treatment outcome in malaria, where there are chances of mixed infection please recommend Arteplus/CD.

Condition • Region is endemic for malaria. • Chloroquine resistant strains of P.vivax and P.falciparum are seen in the region. • More cases of malaria were due to falciparum. • Prevailing sulphur drug sensitivity in the region

Situation-2 Sulfa + Pyri in CQ resistant vivax & uncomplicated falciparum malaria. Patient concern :• Patient is having high grade fever with moderate chills. • Rigors along with vomiting and malaise • Feeling of weakness ,loss of appetite

Therapeutic needs • Instant relief from fever and rigors • Prevention of recrudescence. • To prevent the infection from becoming severe

Focus point • To provide relief from fever and other symptoms of malaria. • To prevent recrudescence of the infection in falciparum malaria.

Call objective • To convert Sulfadoxine - Pyrimethamine Rxer to Arteplus/ CD in CQ resistant vivax and uncomplicated falciparum malaria.

Need identification • How frequently do you come across CQ resistant malaria cases? • What is your drug of choice in such cases? • Are you looking for a drug which can be used empirically for CQ resistant as well as uncomplicated falciparum malaria?

Benefit presentation • Dr. this article was published in Parassitolgia 2004. In this article WHO has recommended the use of AL in all the countries experiencing resistance to conventional therapies like CQ or sulfadoxine/pyrimethamine.

Benefit presentation • Dr. this article was published in American journal of tropical hygiene,2007. This study was conducted on 99 Nepalese patients with uncomplicated falciparum malaria. • Conclusion :- AL was found to be more effective than SP for uncomplicated Falciparum malaria.

• What is your opinion regarding the use of Arteplus /CD in CQ resistant or uncomplicated falciparum malaria cases?

Commitment • Dr. in coming 5 cases of CQ resistant and uncomplicated malaria cases, please recommend Arteplus /CD.

Condition • Dr’s using plain artemisinin compound in the treatment of uncomplicated falciparum malaria. • Incidences of resistance against CQ and other antimalarials are on a rise.

Situation – 3 Artemether tab in uncomplicated Falciparum malaria. • • • •

Patient concern :Patient is having high grade fever with moderate chills. Rigors along with vomiting and malaise Feeling of weakness Loss of appetite

Therapeutic needs • To reduce FCT & PCT • To prevent recrudescence of the infection • Prevention of the emergence of the resistance

Focus point • To provide relief from fever and other symptoms of malaria. • To prevent recrudescence of the infection in falciparum malaria. • To prevent emergence of resistance against other antimalarials.

Call objective • To convert plain artemether Rxer to Arteplus / CD or Falcigo plus in uncomplicated falciparum malaria.

Need identification • What is your line of treatment in Uncomplicated falciparum malaria ? • How frequently do you see the infection reappearance in such cases even after the treatment with plain artemisinin compound? • In such cases are you looking for a drug which will not only help in preventing recrudescence but will also reduce the likelihood of emergence of resistance against other antimalarials?

Benefit presentation • Dr. this study was published in Expert opinion on investigational drugs, 2000. It suggests that Artemisinin compounds like Artemether or Artesunate should be combined with long acting antimalarials like Lumefantrine or Mefloquine to prevent recrudescence, to improve compliance and to prevent progression of resistance against antimalarials.

• How well do you think that Arteplus /CD or Falcigo plus can help you in preventing the recrudescence, the emergence of resistance and faster resolution of symptoms in uncomplicated falciparum malaria ?

Commitment • Dr. In your forthcoming patients suffering from uncomplicated falciparum malaria depend on Arteplus /CD for the prevention of recrudescence, emergence of resistance and faster resolution of symptoms.

Condition • Endemic region for malaria • Resistant strains of vivax and falciparum are common in the region. • Several deaths were reported due to malaria

Situation-5 Arteether /Artemether Inj. In Severe malaria • Patient is having high grade fever with chills. • Severe headache and fatigue • Respiratory distress. • Jaundice • Unconscious

Therapeutic needs • Save the life of the patient. • To prevent other complications. • Faster clearance of the parasite from the blood. • To maintain high and sustained concentration of the drug in the blood to prevent recrudescence and to prevent resistance development.

Focus point • To save the life of the patient by having profound (fast and long) action of the drug. • To prevent further complications like organ damage.

Call objective • To convert plain artemether /arteether Rxer to Falcigo Inj. in severe malaria.

Need identification • What are the objectives of treatment in severe falciparum malaria ? • Which are the important parameters you are looking in for while Rxing a drug in such cases ? • How important is the quick absorption and safety of the drug in such situations?

Benefit presentation • This article was published in New England journal of medicine, 2008. This article clearly states that the efficacy of the fat soluble artemisinin compounds i.e. arteether & artemether in severe malaria is limited due to its varied absorption (they are given IM). Artesunate is having more reliable pharmacokinetic profile as it is water soluble (given IV).

Benefit presentation • Dr. the same study speaks about the safety profile of AS as fat soluble artemisinins were found to be more neurotoxic as compared to AS. • AS dosage need not be changed in hepatic and renal failure cases. • No drug interaction is seen so far with AS.

• How well do you think that Falcigo can help you in saving the life and preventing further complications in severe falciparum malaria ?

Commitment • Dr. In your forthcoming patients suffering from severe malaria, depend on Falcigo inj. & tab for saving the life and preventing further complications.

Condition • Endemic region for malaria. • Many deaths has happened due to malaria • Mostly P.falciparum was seen to be responsible for causing malaria. • MDR strains of falciparum are common in the region.

Situation-6 Quinine Inj. In Severe malaria • • • • •

High grade fever. Severe headache and fatigue Respiratory distress/ Dyspnea. Jaundice Unconscious

Focus point • To save the life of the patient • To prevent further complications like organ damage.

Call objective • To convert plain Quinine Rxer to Falcigo Inj. in severe malaria.

Need identification • What are the objectives of treatment in severe falciparum malaria ? • Which are the important parameters you are looking in for while Rxing a drug in such cases ? • How important is the risk reduction of death and safety of the drug in such situations?

Benefit presentation • This article was published in New England journal of medicine, 2008. This article clearly states that risk reduction of death was 34.7% more with AS as compared with Quinine. • Artesunate was found to be having least side effects unlike Quinine having hypoglycemia, visual disturbances and tinnitus as common one.

• How well do you think that Falcigo can help you in saving the life and preventing further complications in severe falciparum malaria ?

Commitment • Dr. In your forthcoming patients suffering from severe malaria, depend on Falcigo inj. & tab for saving the life and preventing further complications.