Anti-malarials

Malaria
Uncomplicated malaria Severe malaria

Vivax malaria

Falciparum malaria

Vivax malaria

Falciparum malaria

Negligence

CQ resistance

Chloroquine (Oral) Amodiaquine

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 Aremether in UC falci. Malaria Arte-CD Falcigo plus Arteether in Severe Malaria Falcigo Falcigo plus CQ in severe SP in UC vivax malaria Falci. Falcigo/plus Malaria Arte/Fal plus Quinine 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.

Feedback
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.

Feedback
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
Drs 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.

Feedback
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.

Feedback
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.

Feedback
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.