Post on 07-Jul-2018
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PENATALAKSANAANPENATALAKSANAAN
KASUS MALARIAKASUS MALARIA20112011
Dr. Paul Harijanto, SpPD-KPTIDr. Paul Harijanto, SpPD-KPTI
RSU Bethesda GMIM TomohonRSU Bethesda GMIM Tomohon
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ANTI- MALARIAANTI- MALARIA
PROPHYLACTIC DRUGSPROPHYLACTIC DRUGS
BLOOD SCHIZONTOZIDAL DRUGSBLOOD SCHIZONTOZIDAL DRUGS
TISSUE SCHIZONTICIDAL DRUGS TISSUE SCHIZONTICIDAL DRUGS
GAMETOCYTOCIDAL DRUGSGAMETOCYTOCIDAL DRUGS
HYPNOZOITOCIDAL DRUGSHYPNOZOITOCIDAL DRUGSSPORONTOCIDAL DRUGSSPORONTOCIDAL DRUGS
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METHOD of TREATMENTMETHOD of TREATMENTCURATIVE THERAPYCURATIVE THERAPY
RADICAL ( ki !"#"$i%& " $%"'&$ RADICAL ( ki !"#"$i%& " $%"'&$
MASS T#&"%)&*%MASS T#&"%)&*%
CLINICAL C+#&CLINICAL C+#&
PROPHYPACTIS THERAPYPROPHYPACTIS THERAPY
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ANTI-MALARIA DRUG INANTI-MALARIA DRUG IN
INDONESIAINDONESIAArtemisinin ( ArtemisininArtemisinin ( Artemisinin
Combination Therapi = ACT)Combination Therapi = ACT)
PrimaquinePrimaquineQuinineQuinine Chloroquine (CQ )Chloroquine (CQ ) Sulphadoxine – Pyrimethamine (SP)Sulphadoxine – Pyrimethamine (SP)
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MORTALITY
0,1 ."$& f"%"i%/ #"%& !#oi&!#o)!% "* &&.%i& %#&"%)&*%
I*&&.%i&3 &"/&
$&&)""#i"
S&& )""#i"3 )o#%"i%/ 14 5 20
U*%#&"%& $&& )""#i"3 ")o$%"6"/$ f"%"
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DIAGNOSISDIAGNOSISP#&$&*%"$i Ki*i$ B"#i"$iP#&$&*%"$i Ki*i$ B"#i"$i
G&7"" D&)") $i*' ik&i#+k"* &*'"*G&7"" D&)") $i*' ik&i#+k"* &*'"*i*f&k$i "i* ( Tifoi3 D&*'+&3i*f&k$i "i* ( Tifoi3 D&*'+&3L&!%o$!i#o$i$3 C8i*'k+k+*/"3 ISPA L&!%o$!i#o$i$3 C8i*'k+k+*/"3 ISPA
Ko)!ik"$i !&*+#+*"* k&$""#"*3 $i*'Ko)!ik"$i !&*+#+*"* k&$""#"*3 $i*'ik&i#+k"* &*'"* )&*i*'i%i$3ik&i#+k"* &*'"* )&*i*'i%i$3&*$&f"i%i$3 &*$&f"o!"%i "i**/"&*$&f"i%i$3 &*$&f"o!"%i "i**/"
9"+*i.&:ik%ik $i*' ii"'*o$i$ 9"+*i.&:ik%ik $i*' ii"'*o$i$$&;"'"i 8&!"%i%i$ "%"+ ko&$i$%i%i$$&;"'"i 8&!"%i%i$ "%"+ ko&$i$%i%i$
DETEKSI PARASIT ( MIKROSKOPIK "%"+DETEKSI PARASIT ( MIKROSKOPIK "%"+
RDT RDT
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TREATMENT OB9ECTIVES
U*.o)!i."%& )""#i" < C+#& i*f&.%io* P#&&*% !#o'#&$$io* $&& i$&"$& P#&&*% )o#;ii%/ "$$o.i"%& 6i%8 %#&"%)&*%
f"i+#& R&+.& %#"*$)i$$io* P#&&*% %8& &)'&*.& = $!#&" #&$i$%"*.&
"*%i)""#i"
S&& M""#i"
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P"$i&* )""#i",, M&*''i'i3 ;$&i)+% &*'k"!
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Gejala MalariaGejala Malaria
Karakteristik : Demam periodik, Anemia, SplenomegaliKarakteristik : Demam periodik, Anemia, Splenomegali D&)") !ioik ( > T#i"$ M""#i" >
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P, Vi"@ P, M""#i"&
P, ".i!"#+)
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11
Case 1.
Laki-laki, 31 tahun, pekerja tambang emas di Halmahera
(Gosowo) masuk R, 31 !ktober "##$ dengan keluhan %&'&
'G', * hari sebelum masuk R+ Lima hari sebelumna pasien
juga merasa sakit perut,bab air 1., Riwaat %enakit ahulu /
eptember "##$ Malaria 0ia. di Halmahera diobati 2lorouin "-
"-1 dan %rimakuin 1." tablet selama 1* hari+
Pemeriksaan Fisik : adar, 4 13#56#mmHg, nadi $7.5menit,suhu *#89, tidak tampak anemia, lera tidak iteri+ :antung
dan %aru dalam batas normal+ &bdomen; supel,neri tekan
epigastrium(>>>> ?
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1414
DISKUSI <1,G&7"" &)") = i"#& < ( G&7"" *o*-k"$ik 2,P"$)oi+) Vi"@ Ri*' 3 $"%+ ;+"*$&;&+)*/" i"@ !o$, ( R&"!$ : R&-.#+&*$i : R&-i*f&k$i
, H"$i L";o#"%o#i+) < T#o);o$i%o!&*i"( 1,000: )), Si*' ii"'*o$& D&*'+&( A!" DD */"
, P&*'o;"%"* M""#i" $&;&+)*/" &*'"* <CF PF 2 %;:1 8"#i, ( A!" !&*'o;"%"*
/"*' ;&*"#
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P&*/&;"; T#o);o$i%o!&*i"P&*/&;"; T#o);o$i%o!&*i"
D&f&.%$ of %8& )"##o6D&f&.%$ of %8& )"##o6
S&+&$%#"%io* +& %o $!&*o)&'"/S&+&$%#"%io* +& %o $!&*o)&'"/
A..&"%& &$%#+.%io*
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Di"'*o$"Di"'*o$"B"*i*'
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Hemato#og$ indings in a&ute s$m'tomati& un&om'#i&atedHemato#og$ indings in a&ute s$m'tomati& un&om'#i&ated
P.falciparumP.falciparum ma#aria 'atients on admission ()*6+ma#aria 'atients on admission ()*6+
-nemia (%-nemia (% : +9: +9 (61.9(61.9
Hemog#obin: means (rangegd# : 1.+Hemog#obin: means (rangegd# : 1.+ (6.1 / 15.(6.1 / 15.
r$t2ro&$te: means (rangeu# in mi##ionr$t2ro&$te: means (rangeu# in mi##ion : 4.9: 4.9 (.6 35.9+(.6 35.9+
Leuko&$te: means (rangeu#Leuko&$te: means (rangeu# : 5,+ (,600 3 11,00: 5,+ (,600 3 11,00
#ate#et: means (rangeu# in t2ousand#ate#et: means (rangeu# in t2ousand : 9: 9 (15 3 1(15 3 1
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PENGOBATAN
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PLASMODIUM KNOLESIPLASMODIUM KNOLESI T8& > if%8 > M""#i" T8& > if%8 > M""#i"
D++ 8"*/" )&*'i*f&k$i k" (M"."." M+"%"D++ 8"*/" )&*'i*f&k$i k" (M"."." M+"%" S&7"k %8 200 i"!o#k"* #&%#o$!&k$if i S"6"kS&7"k %8 200 i"!o#k"* #&%#o$!&k$if i S"6"kV&.%o# A*o!8&&$ &+.o$!8/#+$ '#o+! (A*, L"%&*3V&.%o# A*o!8&&$ &+.o$!8/#+$ '#o+! (A*, L"%&*3
.#".&*$.#".&*$Mi$i"'*o$i$ $&;"'"i )""#i" )""#i"&3Mi$i"'*o$i$ $&;"'"i )""#i" )""#i"&3
)ik#o$ko!ik )&*/+!"i P, )""#i"&)ik#o$ko!ik )&*/+!"i P, )""#i"& Ki*i$ TIDAK $&!%i )""#i"&Ki*i$ TIDAK $&!%i )""#i"&3 &)") %i"! 2 7")33 &)") %i"! 2 7")3
i"#&"3 */i ";o)&* "* i%&)+k"*i"#&"3 */i ";o)&* "* i%&)+k"*8i!!"#"$i%&)i" 240,000:+L8i!!"#"$i%&)i" 240,000:+LD"!"% )&);ik"* ko)!ik"$i ik%ik3 8i!o%&*$i3D"!"% )&);ik"* ko)!ik"$i ik%ik3 8i!o%&*$i3
'"'" 'i*7"3 $&;#" "* '"'" !*"f"$"*'"'" 'i*7"3 $&;#" "* '"'" !*"f"$"*
Di"'*o$" !"$%i i&*%i?k"$i &*'"* PCRDi"'*o$" !"$%i i&*%i?k"$i &*'"* PCR
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M""#i" K*o6&$i
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DETEKSI DINI KASUS MALARIADETEKSI DINI KASUS MALARIA
DEMAM TIFOIDDEMAM TIFOID
Limpa, Hati, Kel. Limfe,Limpa, Hati, Kel. Limfe,
Ikterik, etekie!, Uri!, "a!##$a! kesa%ara!Ikterik, etekie!, Uri!, "a!##$a! kesa%ara!
DEMAM DEN"UEDEMAM DEN"UEMALARIAMALARIAMikr&sk' ()C ' Rapi% testMikr&sk' ()C ' Rapi% test
Demam'Ri*a+at Demam,Demam'Ri*a+at Demam,
Sakit kepalaSakit kepala
e!#&ata! Malariae!#&ata! Malaria
A!am!esaA!am!esa
emeriksaa! Fisikemeriksaa! Fisik
Trias MalariaTrias Malaria
Ri*a+at er-ala!a!Ri*a+at er-ala!a!
)erkema')er$r$')erkema')er$r$'
Ri*a+at akai Oat MalariaRi*a+at akai Oat Malaria
e!%ata!#'ela!/&!#e!%ata!#'ela!/&!#
Kea%aa! !&!0im$!Kea%aa! !&!0im$!
Kel$a! A%&me!Kel$a! A%&me!
)ra%ikar%i relatif )ra%ikar%i relatif
R&se sp&tR&se sp&t
N+eri Ot&tN+eri Ot&t
Ras petekie!Ras petekie!
Tes R$mpel Lee%eTes R$mpel Lee%e
er%araa!er%araa!
LETOSIROSISLETOSIROSIS
N+eri Ot&tN+eri Ot&t
N+eri )etisN+eri )etis
Trias MalariaTrias Malaria
$/at' a!emis$/at' a!emis
Sple!&me#aliSple!&me#ali
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PASIEN DENGAN DEMAMPASIEN DENGAN DEMAM
B#"!" ")" D&)") B#"!" ")" D&)")
DEMAM
D&)")Ak+%
1 8"#i
D&)")K#o*ik 1 8"#i
I*f&k$i k#o*ik < TBC3 E*ok"#i%i$3 HIV:AIDSL&!#"
M"i'*"*./ <L&+k&)i"3 Li)fo)"
I)+*oo'ik <SLE3 RA3
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TIPE E!A!Tipe Karakter Contoh
Kontinyu Terus menerus tinggibeda 0,5/1
Tioid, H7, drug e8er
Intermiten Tem' turun sam'ainorma# setia' 2ari
Ineksi 'iogenik,#imoma, TB,
Remiten 7#uktuasi 2arian ,ta'i tak 'erna2 norma#
a#aria
Berulang(Relaps)
;u2u turun sam'ainorma# bbr' 2arimeningkat #agi
a#aria
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PENYEBAB DEMAM
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PENYEBAB DEMAMPENYEBAB DEMAMINEKSI
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Tro' ed Int Hea#t2. 011 )o8 1. doi: 10.1111C.1+65/+156.011.091.D. E'ub a2ead o 'rintFTro' ed Int Hea#t2. 011 )o8 1. doi: 10.1111C.1+65/+156.011.091.D. E'ub a2ead o 'rintF
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Tro' ed Int Hea#t2. 011 )o8 1. doi: 10.1111C.1+65 +156.011.091.D. E'ub a2ead o 'rintFTro' ed Int Hea#t2. 011 )o8 1. doi: 10.1111C.1+65 +156.011.091.D. E'ub a2ead o 'rintF
Malaria pre4alen"e and treatment o/ /e5rile patients at 6ealt6 /a"ilities and medi"ine retailers in 0ameroon7Malaria pre4alen"e and treatment o/ /e5rile patients at 6ealt6 /a"ilities and medi"ine retailers in 0ameroon7
ang2am LG, undi## B, -&2ondu2 -, -mbebi#a G), Le#e -, eto2 T), )di8e ;), )dong I, )gue#a
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M""# 9, 200 9"* 21
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Golongan ARTEMISININGolongan ARTEMISININArtemisinin, Artes'nate, Artemet6er, Arteet6er, D.AArtemisinin, Artes'nate, Artemet6er, Arteet6er, D.A
O 881ing6aos'9 Ses;'iterpene La"tone1ing6aos'9 Ses;'iterpene La"tone
O Lar't dalam air dan dia5sor5si 5aikLar't dalam air dan dia5sor5si 5aik
O E/ek 5'n'6 parasit 0epat dikon4ersi ke 5a6an akti/ = D.A>
O tt2!?2!? in malaria: ? 6o'rsin malaria: ? 6o'rs
O Spektr'm
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A#%&)i$i*i*-;"$& Co);i*"%io*A#%&)i$i*i*-;"$& Co);i*"%io* T8"!/ (A,C,T T8"!/ (A,C,T
R"!i ."*.& !"#"$i%&$R"!i ."*.& !"#"$i%&$
R"!i #&$o+%io* of $/)!%o)$R"!i #&$o+%io* of $/)!%o)$
R&+.& !"#"$i%&$ ;/ 10,000:./.& (!"$%R&+.& !"#"$i%&$ ;/ 10,000:./.& (!"$%
"*%i)""#i" o*/ 100-1000 !"#"$i%&$:"*%i)""#i" o*/ 100-1000 !"#"$i%&$:./.&./.&
Ei)i*"%& #"!i/
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Te i%eal2 ACT /&mi!ati&!Te i%eal2 ACT /&mi!ati&!
Resisten obat pasangan belum terjadi, kerja ang bedaResisten obat pasangan belum terjadi, kerja ang beda %asangan obat mempunai hal@-li@e panjang (A * hr)%asangan obat mempunai hal@-li@e panjang (A * hr) &rtemisinin membunuh bentuk ase.ual dgn epat/ &rtemisinin membunuh bentuk ase.ual dgn epat/
pasangan obat membersihkan parasit lainnapasangan obat membersihkan parasit lainna
itolerensi baik, toksisitas rendahitolerensi baik, toksisitas rendah &rtemisinin memiliki e@ek spetrum luas ( termasuk &rtemisinin memiliki e@ek spetrum luas ( termasuk
membunuh gametosit)membunuh gametosit) Bila mungkin dosis tetap (Ci.ed dose ), 3 hari regimeBila mungkin dosis tetap (Ci.ed dose ), 3 hari regime
iproduksi seara standar D Good Manu@aturing %ratieiproduksi seara standar D Good Manu@aturing %ratie(GM%) D(GM%) D
MurahMurah uppl obat ukupuppl obat ukup
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0RRENT APPROA0. MALARIA TREATMENT0RRENT APPROA0. MALARIA TREATMENT
)ased on mi"ros"opi" diagnosis)ased on mi"ros"opi" diagnosis 0om5ination t6erap
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TREATMENT O UNCOMPLICATEDP, ALCIPARUM MALARIA
U*.o)!i."%& < $/)!%o)"%i.6i%8o+% $i'*$ of $&i%/ o# &i&*.&of i%" o#'"* /$f+*.%io*
To i)!#o& o+%.o)& A*%i M""#i"Co);i*"%io* (AMC i$ #&.o))&*&
AMC < $i)+%"*&+$ +$& of 2 ;oo$.8io*%o.i" #+'$ 6i%8i*&!&*&*% )o&$ of ".%io*,
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R"%io*"& fo# AMC
%8"!/ < Co);i*"%io* i$ )o#& &&.%i&
I* #"#& &&*% 3 " )+%"*% !"#"$i%& %8"% i$
#&$i$%"*% i$ ki& ;/ o%8 #+', To !#&&*%: &"/ %8& &)'&*.& of
#&$i$%"*.&
T8& 2 #+'$ )+$% ;& i*&!&&*%/ &&.%i&
T8& i$""*%"'&$ i$ !o%&*%i" i*.#&"$&"$& &&.%$ "* i*.#&"$& .o$%
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ACT /"*' "" i I*o*&$i"ACT /"*' "" i I*o*&$i"
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006
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P&*'o;"%"* M""#i"P&*'o;"%"* M""#i" T"*!" Ko)!ik"$i ALSIPARUM:VIVAQ T"*!" Ko)!ik"$i ALSIPARUM:VIVAQ
M""#i" RINGAN: T"*!" Ko)!ik"$i
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Hari
3e!is &at 3$mla talet me!$r$t kel&mp&k $m$r
D&sist$!##al
4 5 1$la!
6 5 11$la!
1 0 7ta$!
8 0 9ta$!
14 0 17ta$!
: 18ta$!
1 &rtesunate I J 1 " 3 *
&modiakuin I J 1 " 3 *
%rimakuin -- -- K 1 J " " - 3
" &rtesunate I J 1 " 3 *
&modiakuin I J 1 " 3 *
3 &rtesunate I J 1 " 3 *
&modiakuin I J 1 " 3 *
P&*'o;"%"* Li*i I3 P, "$i!"#+) )&*+#+% +)+#
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A%"+A%"+Di8/#o"#%&)i$i*i* !i!"+i* Di8/#o"#%&)i$i*i* !i!"+i*
P#i)"k+i*P#i)"k+i*
Ef&k%if +*%+k ".i!"#+) "* Vi"k$ DC B"#+ %$&i" i ;;#! !#o!i*$i < I*o*&$i" Ti)+#3 S+)"%#" Di$i"!k"* +*%+k $&+#+8 I*o*&$i"
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P&*'o;"%"* &*'"* Di8/#o"#%&)i$i*i*-Pi!"k+i*P&*'o;"%"* &*'"* Di8/#o"#%&)i$i*i*-Pi!"k+i*(DH-P(DH-P
ta;ta;3n3n
1010 5 5 11
ta;3nta;3n
?? 1515
ta;3ta;3nn
11 D
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Li*i k&+"Li*i k&+"
Ki*" Dok$i$iki*: T&%#"$iki* P#i)"k+i*Ki*" Dok$i$iki*: T&%#"$iki* P#i)"k+i*
P ; % i i II % %if k ;i i Ki D k i iki :
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Hari :enis obat :umlah tablet menurut kelompok umur
osis tunggal #-11bulan
1 - *tahun
N - $tahun
1# - 1*tahun
A 1Ntahun
1 2ina O) 3 . J 3 . 1 3 . 1 J 3 . ("-3)
oksisiklin -- -- -- " . N# mg " . 1## mg
%rimakuin - K 1 J " " E 3
" - P 2ina O) 3 . J 3 . 1 3 . 1 J 3 . "
oksisiklin -- -- -- " . N# mg " . 1## mg
osis 4F4R&2L' -- -- -- *.* mg5kgBB
* . "N# mg
osis9L'&MQ9'
-- -- -- ".1# mg5kgBB
".1# mg5kgBB
P&*'o;"%"* i*i II "%*"%if ko);i*"$i Ki*" Dok$i$iki*: T&%#"$iki*: Ci*")/.i* ( ;i" '"'" !&*'o;"%"* i*i I
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ACT $&k%o# $6"$%"ACT $&k%o# $6"$%"
A#%&)&%8-L+)&f"*%#i*& ( Co-A#%&)&%8-L+)&f"*%#i*& ( Co-A#%&) A#%&) DCDC
Ef&k%if +*%+k f".i!"#+)Ef&k%if +*%+k f".i!"#+)
K+#"*' &f&k%if +*%+k i"k$K+#"*' &f&k%if +*%+k i"k$
Do$i$ 2 @ $&8"#iDo$i$ 2 @ $&8"#i
A;$o#!$i )&*i*'k"% '* &)"k ( $+$+A;$o#!$i )&*i*'k"% '* &)"k ( $+$+
Li i II ACT D i % % f % i (A L
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3e!is &at Um$r > ?ta$!
: ? 0 @ta$!
: 9 5 17t
: 17 t
Hari Berat Badan(2g)
:am N E 1*kg
1N E "* kg "N E 3*kg
A 3* kg
1 & - L # jam 1 " 3 *
& - L 6 jam 1 " 3 *%rimakuin 1" jam K 1 J " " - 3
" & - L "* jam 1 " 3 *
& - L 37 jam 1 " 3 *
3 & - L *6 jam 1 " 3 *
& - L 7# jam 1 " 3 *
Li*i II ACT, Do$i$ !&*''+*""* "#%&)&%-+)&f"*%#i*& (A-L
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M""#i" Vi"k$ = O"&M""#i" Vi"k$ = O"&
M""#i" Vi"k$ = O"&
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Hari
3e!is &at 3$mla talet me!$r$t kel&mp&k $m$r
D&sis
t$!##al
4 5 1
$la!
6 5 11
$la!
1 0 7
ta$!
8 0 9
ta$!
14 0 17
ta$!
: 18
ta$!1 &rtesunate I J 1 " 3 *
&modiakuin I J 1 " 3 *
%rimakuin -- -- 15* 15" 35* 1
" &rtesunate I J 1 " 3 *
&modiakuin
%rimakuin
I J 1
15*
"
15"
3
35*
*
1
3
*-1*
&rtesunate I J 1 " 3 *
&modiakuin
%rimakuin
%rimakuin
I J 1
I
15*
"
J
15"
3
K
35*
*
1
1
P&*'o;"%"* Li*i I3 Vi"k$ )&*+#+% +)+#
P&*'o;"%"* &*'"* Di8/#o"#%&)i$i*i* Pi!"k+i*P&*'o;"%"* &*'"* Di8/#o"#%&)i$i*i*-Pi!"k+i*
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LASI*IASI RESPON PENGO#ATAN ( @
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Datang
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%anas,dingin
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H0: 7a#&i' ring
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PENGOBATAN KEGAGALANPENGOBATAN KEGAGALAN( R&$+& %#&"%)&*% Li*i( R&$+& %#&"%)&*% Li*i
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Hari :enis obat :umlah tablet menurut kelompok umur
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Hari :enis obat :umlah tablet menurut kelompok umur
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Hari
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ANTI-#IOTIANTI-#IOTI
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NE ANTI MALARIA DRU"SNE ANTI MALARIA DRU"S
MELOFUIN ( L"#i")MELOFUIN ( L"#i")HALOANTRINE ( H"f"*HALOANTRINE ( H"f"*
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NE ANTI MALARIA DRU"S 0 6NE ANTI MALARIA DRU"S 0 6
ATOVAKONATOVAKON YINGHAOSU YINGHAOSU
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PAATUAN @O PAALA@IREN
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PAATUAN @O PAALA@IREN
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(DH-P(DH-P
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I*%#" M+$.+"# ARTS $ ARTMI*%#" M+$.+"# ARTS $ ARTM
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I*%#" M+$.+"# ARTS $ ARTMI*%#" M+$.+"# ARTS $ ARTM
ARTSARTS ARTMARTM
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POTENTIAL COMBINATION CHEMOTHERAPYPOTENTIAL COMBINATION CHEMOTHERAPY
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POTENTIAL COMBINATION CHEMOTHERAPYPOTENTIAL COMBINATION CHEMOTHERAPY
Unregistered + existing drugs Unregistered + existing drugs Art!+C"!# Art!+SP$# A"!+SP$# M"$+SP$#Art!+C"!# Art!+SP$# A"!+SP$# M"$+SP$#
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ARTEMISININ DERIATIESARTEMISININ DERIATIES
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ARTEMISININ DERIATIESARTEMISININ DERIATIESArtemisinin, Artes'nate, Artemet6er, Arteet6er,Artemisinin, Artes'nate, Artemet6er, Arteet6er,
D.AD.A
O 881ing6aos'9 Ses;'iterpene La"tone1ing6aos'9 Ses;'iterpene La"tone
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O ell toleratedell tolerated
O Rapidl< "on4erted to a"ti4e meta5oliteRapidl< "on4erted to a"ti4e meta5olite
O tt2!?2!? in malaria: ? 6o'rsin malaria: ? 6o'rs
O )road spe"i/i"it< o/ a"tion)road spe"i/i"it< o/ a"tion
O Etremel< PotentEtremel< Potent
O Long "o'rses needed in monot6erap
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0OM)INATION T.ERAP0OM)INATION T.ERAP
O ell mat"6ed PK ! PD propertiesell mat"6ed PK ! PD properties
O S
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DERIATIE IT. A LONG A0TING ANTIMALARIAL
ILL )E :O Impro4e e//i"a"< o/ a 8d
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MALARIA IN INDONESIAMALARIA IN INDONESIA
Sa/e and toleran"e /or all age gro'ps7Sa/e and toleran"e /or all age gro'ps7
E//e"ti4e and rapid response /or 5ot6 P/ and P4E//e"ti4e and rapid response /or 5ot6 P/ and P4S6ort "o'rse and good "omplian"eS6ort "o'rse and good "omplian"e
Resistan"e and!or "rossBresistan"e not
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0OM)IN0OM)INATION T.ERAPATION T.ERAP
O Artemisinin 0ontaining 0om5ination T6erap=A0T>
O Non A0T:Non A0T:
O SP # 01SP # 01
O 1'inine # Do
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DERIATIE IT. A LONG A0TING
ANTIMALARIAL IN ARI0AO Impro4es e//i"a"< o4er monot6erap
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Combinations should contain an
artemisinin derivative
0ANDIDATES OR A0T0ANDIDATES OR A0T
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0ANDIDATES OR A0T0ANDIDATES OR A0T
O Me/lo;'ineMe/lo;'ine
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Con3entration A"TS 4 A a.ter i/m/ A"TS
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C&artemeter
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RECOMMENDATIONRECOMMENDATION
E,PERT COMMITE ON MALARIAE,PERT COMMITE ON MALARIADIAGNOSIS TREATMENT DIAGNOSIS TREATMENT
2 OKTOBER 2002 OKTOBER 200
20 MEMBER INDONESIAN EQPERT20 MEMBER INDONESIAN EQPERTCOMMITTECOMMITTE
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2006
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Updated5 March 2008
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