Pengobatan Mal Ringan

8/19/2019 Pengobatan Mal Ringan

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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 *


3 &rtesunate 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 . "


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


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 *


%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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UNTUK VIVAKSUNTUK VIVAKS

ta;ta;3n3n

1010 5 5 11

ta;3nta;3n

?? 1515

ta;3ta;3nn

1--,1--, D


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M"*"'&)&*% T#&"%)&*%M"*"'&)&*% T#&"%)&*%"i+#&$"i+#&$

T#&"%)&*% f"i+#& 6i%8i* 1 "/$ / T#&"%)&*% f"i+#& 6i%8i* 1 "/$ /+*+$+"


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$ *uideline +,,- on treatment .ailure

LASI*IASI RESPON PENGO#ATAN ( @


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LASI*IASI RESPON PENGO#ATAN ( @


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Datang

RS!Dr

H-2 H0

.asil

Mal #

H-1

M'lai

O5at

H1

H2

H

H

H4 H H

H1 H21

H2

KlinisMem5'r'k

/Klinis mem5'r'k/B Parasit $ 5an


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%anas,dingin

36+*9

Cal, ring

3*# par5"## L

H1 H"

C,ring3#"*5 "##L

9 *5*5"< %3

H3

C,ring

11P par5"##L

2ina tb

3 . 3 tb5 P hari

E/T/0

HP

1asus !alaria *a2al $bat ini

E/T/0

KASUS MALARIA


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H0: 7a#&i' ring

19000#euko

01* H: 7a#&i' ring

1900#euko

H+: 7a#&i' ring

150000#euko

H4 .-: 7a#&i' ring

1600#euko, SP2

H5 .2: 7a#&i' ring

41600#euko

H6 .?: 7a#&i' ring

4 00#euko

H .* : 7a#&i' ring

00#euko

Tem' +

ina + D tab

KASUS MALARIATANPA KOMPLIKASIMULTI-DRUGSRESISTANCE

.5: 2%7 g!dl

Le'ko : ---

Trom5o:3%7---

)il:?7H

0reat : 2723


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60/125


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( 8", 1

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rug regimens @or prophla.is against malaria


82/125

gg

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NE DRUGS Co);i*"%io* 7ansidar ( ; @ me#ouin (Q ,7ansidar ( ; @ me#ouin (Q , ( 7-);I7 ( 7-);I7

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84/125

ANTI-#IOTIANTI-#IOTI

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85/125

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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86/125

NE ANTI MALARIA DRU"S 0 6NE ANTI MALARIA DRU"S 0 6

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ETAKUIN: PIPERAKUINETAKUIN: PIPERAKUINBENLUMETOLBENLUMETOL

PAATUAN @O PAALA@IREN


87/125

PAATUAN @O PAALA@IREN

r. au# HariCanto, ;'./TIi8. en$akit Tro'ik P Ineksi

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90/125

(DH-P(DH-P

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91/125


92/125


93/125


94/125

I*%#" M+$.+"# ARTS $ ARTMI*%#" M+$.+"# ARTS $ ARTM


95/125

I*%#" M+$.+"# ARTS $ ARTMI*%#" M+$.+"# ARTS $ ARTM

ARTSARTS ARTMARTM

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POTENTIAL COMBINATION CHEMOTHERAPYPOTENTIAL COMBINATION CHEMOTHERAPY


96/125

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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L&!d%!# L&!d%!+Art!L&!d%!# L&!d%!+Art!


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ARTEMISININ DERIATIESARTEMISININ DERIATIES


98/125

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

O ell a5sor5edell a5sor5ed

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


99/125

0OM)INATION T.ERAP0OM)INATION T.ERAP

O ell mat"6ed PK ! PD propertiesell mat"6ed PK ! PD properties

O S


100/125

DERIATIE IT. A LONG A0TING ANTIMALARIAL

ILL )E :O Impro4e e//i"a"< o/ a 8d


101/125

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


102/125

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


103/125

DERIATIE IT. A LONG A0TING

ANTIMALARIAL IN ARI0AO Impro4es e//i"a"< o4er monot6erap


104/125

Combinations should contain an

artemisinin derivative

0ANDIDATES OR A0T0ANDIDATES OR A0T


105/125

0ANDIDATES OR A0T0ANDIDATES OR A0T

O Me/lo;'ineMe/lo;'ine

O P


106/125

Con3entration A"TS 4 A a.ter i/m/ A"TS


107/125


108/125

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110/125

Timika, ap$a 3$l+ 64470A$#$st 6448Timika, ap$a 3$l+ 64470A$#$st 6448

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111/125

C&artemeter

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112/125

(DH P(DH P

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113/125

R"%io*"& fo# AMC %8"!/


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115/125

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


116/125

2006

. 2&3nt$ie ;ae a'&te' AT. 2&3nt$ie ;ae a'&te' AT

Updated5 March 2008


117/125

Co*%i*&*%Co*%i*&*% Co+*%#i&$Co+*%#i&$ D#+'D#+' Li*&Li*&

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