Tatalaksana Malaria 2010- Gabungan

8/19/2019 Tatalaksana Malaria 2010- Gabungan

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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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Case 2Case 2

Laki-laki, 42 tahun dnLaki-laki, 42 tahun dn!ala"ia #asi$a"u! a!et%!ala"ia #asi$a"u! a!et%

Telah dikel&la dn Telah dikel&la dna"tesdia'uin dana"tesdia'uin dan$"i!a'uine 2 ta(%$"i!a'uine 2 ta(%

)a"i ke-* a!et !asih)a"i ke-* a!et !asih$enuh$enuh

+(at +(at


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IA.N+SA MALARIAIA.N+SA MALARIA

Clini/al s!$t&! Clini/alClini/al s!$t&! Clini/al

ian&sis ian&sis

Pa"asit&l&i/al ian&sis 3Pa"asit&l&i/al ian&sis 3Mik"&s/&$i/ .ie!sa s!ea" Mik"&s/&$i/ .ie!sa s!ea" entuk A-seksual 5entuk A-seksual 5

RT Ra$id ian&sti/ Test RT Ra$id ian&sti/ Test


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KLASI6IKASI IA.N+SAKLASI6IKASI IA.N+SA

MALARIA AS7MPT+MATIK MALARIA AS7MPT+MATIK

MALARIA KLINISMALARIA KLINIS

MALARIA ERATMALARIA ERATMALARIA ENTUK K)USUS 3MALARIA ENTUK K)USUS 3Mala"ia keha!ilanMala"ia keha!ilan

Mala"ia 8 )I9Mala"ia 8 )I9

Mala"ia Malnut"isiMala"ia Malnut"isi


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ALGORITME PENANGANAN KASUS MALARIAALGORITME PENANGANAN KASUS MALARIA

Tak ada Rpd Tes/

Tak ada Mikrosc

Pem.Mikroskopik

ukan 3

ISPA TI6+I

ISK EN.UE

Le$t&s$i"&sisIn#eksi lain

FalciparumMixed/F+V

Vivax

ERATRinan:Sedan

Parasit ++++/>5%

ata/+ko!p"ikasi #

G$ Kesadara

Ikterik& 'i" > (!$%

Sisto"ik )* !!,$Sesak a-as

O"i$ria/Kreat

Ada Rapid Test/ Tak

ada Mikroskopik

Lii I. 0(+P01

Terapi MalariaBerat

Tes Rapid + Tes Rapid -

ukan 3ISPA

TI6+IISK

EN.UELe$t&s$i"&sis

In#eksi lain

Korfirmasi Mikroskopik

Lii I. 0(+P01

Lii I. 0(+P01

Lii I. 0(+P012

Lii II. 0N*+P01

Lii II. SP1+P01

Lii III. 0N*+P01


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Kasus 2Kasus 2

Ana!nesa3Ana!nesa3 Laki-laki, ;4 tahun tinal di T&!&h&n,Laki-laki, ;4 tahun tinal di T&!&h&n,

datan ke RS denan de!a! sudah ;datan ke RS denan de!a! sudah ;

ha"i% Pende"ita (a"u ti(a da"i Pa$ua 2ha"i% Pende"ita (a"u ti(a da"i Pa$ua 2ha"i lalu dan sudah !e"asa tidak sehatha"i lalu dan sudah !e"asa tidak sehat

P% 6isik 3P% 6isik 3 tensi


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La(&"at&"iu!La(&"at&"iu!

>:10:2011>:10:2011•)(3 ,;00

•)t3 2*?)t3 2*?•Se!en @0?Se!en @0?•Li!#&sit 10?Li!#&sit 10?•R3 6al%"in 5,R3 6al%"in 5,

6al%a!et 56al%a!et 5200 l$3 42 $a"asit200 l$3 42 $a"asit

1000 l$3 2 $a"asit1000 l$3 2 $a"asit

=:10:2011=:10:2011•R3 -R3 -•il%di"e/t3 1,2il%di"e/t3 1,2

•il%indi"e/t3 2,4il%indi"e/t3 2,4•il%t&tal3 ;,=il%t&tal3 ;,=•S.+T3 >1S.+T3 >1•S.PT3 1=S.PT3 1=•U"eu!3 2


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Pen&(atanPen&(atan

A$a Pilihan A$a Pilihan

ACT A$a ACT A$a

Mala"ia (e"at Mala"ia (e"at


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High Levels of DrugResistace i Papua

!liical "tudies #pril $ %ul& '(()

P% #al/i$a"u! C' 5 S$ N10;a 42 C&""e/ted 4


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ACT Clinical Trials in Papua ACT Clinical Trials in Papua

Stud 2

)P Ds AAF

Hasugian et al !ID, :1067-7,2007

Githin 4< h"s3@*? =@0:*12 a$a"asitae!i/@


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"*D, - M-#H#"# R*H"*D, - M-#H#"# R*H

"L#01"-"L#01"-'(()$'((23 "*D, #" + #MD-#4-1'(()$'((23 "*D, #" + #MD-#4-1

4> /ases Hith "st line R3 N& ET6 and > /ases11,11? LT6

1< $asien se/&nd line the"a$ 3 n& ET6 and ; /ases 1=,=*? LT6


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!omparative "tud& of #rteki vs!oartemether

Inte"i! Analsis a 2< Cu"e Rates

>th Jan 2004 N;*>P."al#iparumC&a"te! @0? @;:10; @>? CI3 ?A"tekin @


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*R1#*M1**R1#*M1* PL-!-1"PL-!-1"

II%II% TREATMENT TREATMENT A"te!isininA"te!isinin-(ased-(ased C&!(inati&n The"a$C&!(inati&n The"a$

ACTACT

"*PM*H1R#P,


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Pen&(atan Mala"iaPen&(atan Mala"ia

Tan$a K&!$likasi 6ALSIPARUM:9I9A Tan$a K&!$likasi 6ALSIPARUM:9I9A

Mala"ia RIN.AN: Tan$a K&!$likasi 3Mala"ia RIN.AN: Tan$a K&!$likasi 3A"tesunate 5 A!&dia'uine AS 5 A!&A"tesunate 5 A!&dia'uine AS 5 A!&

ihid"&a"te!isinin Pi$e"akuinihid"&a"te!isinin Pi$e"akuin

A"te!ethe"-Lu!e#ant"ine ALA"te!ethe"-Lu!e#ant"ine AL

Lini Pe"ta!a A%C%T 5 P"i!akuin

• PILI)AN ACT TER.ANTUN. ACT 8 P&la Resistensi• Keaalan $ada AS 5A!& di La!$un, Pa$ua dan SulaHesi Uta• 6C 6ied d&se /&!(inati&n $ilihan• E#ek sa!$in se!ini!al !unkin


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Hari

Jenis obat Jumlah tablet menurut kelompok umur

Dosistunggal 0 – 1bulan 2 – 11bulan 1 - 4tahun 5 - 9tahun 10 - 14tahun > 15tahun

1 Artesunate ¼ ½ 1 2 3 4

Amodiakuin ¼ ½ 1 2 3 4

Primakuin -- -- 1 ½ 2 2 - 3





Pen&(atan Lini I, P% 6alsi$a"u! !enu"ut u!u"


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Pen&(atan denan ihd"&a"te!isinin-Pi$e"akuinPen&(atan denan ihd"&a"te!isinin-Pi$e"akuin

)-P)-PHariHari %eis %eis

o5ato5at

%umlah ta5let meurut kelompok umur %umlah ta5let meurut kelompok umur

6dosis tuggal76dosis tuggal7

( $ 8( $ 8

5ula5ula'' – –

8888 5ul5ul

aa

88 – – ))

tatahuhu

22 – – 99

tahtahuu

8(8( – – 8)8)

tahutahu

:: 8282

tahutahu

88 DHPDHP ¼¼ ½½ 88 832832 '' ; $ ); $ )

F3 H8F3 H8 PrimakuiPrimakui

$$$$ $$$$ 88 ½½ '' ' $ ;' $ ;

'$;'$; DHPDHP ¼¼ ½½ 88 832832 '' ; $ ); $ )Dihydroartemisinin(DH) : 2-4 mg ( 2,2mg)/kgBB (1tablet = 40 mg)i!erak"in !hos!hate(): 1#-$2mg (1%mg/kgBB (1tablet = $20 mg)

rimak"in : 0&' mg/kg BB


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ACT sekt&" sHastaACT sekt&" sHasta

A"te!ethe"-Lu!e#ant"ine C&-A"te!ethe"-Lu!e#ant"ine C&-

A"te! A"te! 6C6C

E#ekti# untuk #al/i$a"u!E#ekti# untuk #al/i$a"u!

Ku"an e#ekti# untuk DiDaksKu"an e#ekti# untuk DiDaks

&sis 2 seha"i&sis 2 seha"i

A(s&"$si !eninkat dn le!ak susuA(s&"$si !eninkat dn le!ak susu


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Jenis obat !mur " #tahun

> # - $tahun

> 9 – 14th

> 14 th

!ari "erat "adan#K$%

&am ' ( 14k$

1' ( 24 k$ 2' ( 34k$

) 34 k$

1 A - * + ,am 1 2 3 4

A - * ,am 1 2 3 4

Primakuin 12 ,am 1 ½ 2 2 - 3

2 A - * 24 ,am 1 2 3 4

A - * 3. ,am 1 2 3 4

3 A - * 4 ,am 1 2 3 4

A - * .+ ,am 1 2 3 4

Lini II ACT% &sis $enunaan a"te!ete"-lu!e#ant"ine A-L


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Hari


Dosis

tunggal

0 – 1

bulan

2 – 11

bulan

1 - 4

tahun

5 - 9

tahun

10 - 14

tahun

> 15

tahun



Primakuin -- -- 1/4 1/2 3/4 1


Amodiakuin

Primakuin

¼ ½ 1

1/4

2

1/2

3

3/4

4

1

3

4-14

Artesunate ¼ ½ 1 2 3 4

Amodiakuin

Primakuin

Primakuin

¼ ½ 1

¼

1/4

2

½

1/2

3

3/4

4

1

1

Pen&(atan Lini I, 9iDaks !enu"ut u!u"


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)-P)-P

UNTUK 9I9AKSUNTUK 9I9AKSHariHari %eis %eiso5ato5at

%umlah ta5let meurut kelompok umur %umlah ta5let meurut kelompok umur6dosis tuggal76dosis tuggal7

( $ 8( $ 8

5ula5ula'' – –

8888 5ul5ul

aa

88 – – ))

tatahuhu

22 – – 99

tahtahuu

8(8( – – 8)8)

tahutahu

:: 8282

tahutahu

8$$;8$$; DHPDHP ¼¼ ½½ 88 832832 '' ; $ ); $ )

V3H8V3H8 – – 8)8)

PrimakuiPrimakui

$$ $$ ¼¼ ½½ 88

Dihydroartemisinin(DH) : 2-4 mg/kgBB (1tablet = 40 mg)i!erak"in !hos!hate(): 1#-$2 mg/kgBB ( 1tablet = $20 mg)

rimak"in : 0&2 mg/kg BB


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Case *Case *

Ada $asien sdh di&(ati ACT,Ada $asien sdh di&(ati ACT,

ha"i ke-4 $a"asit P 6 2: 200ha"i ke-4 $a"asit P 6 2: 200

leuk&, tidak $anas%leuk&, tidak $anas%

A$a ini aal &(at A$a ini aal &(at

Te"a$ina a$a Te"a$ina a$a


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Case =Case =

Pas/a te"a$i ACT ha"us di #&ll&H u$ ha"iPas/a te"a$i ACT ha"us di #&ll&H u$ ha"i*, 14 dan 2< %*, 14 dan 2< %

i Puskes!as te"$en/il tan$a !ik"&sk&$,i Puskes!as te"$en/il tan$a !ik"&sk&$,a$a RT tak (isa untuk #&ll&H u$ a$a RT tak (isa untuk #&ll&H u$

ila )* P# a!et ne% A$a (isa ) 14 atauila )* P# a!et ne% A$a (isa ) 14 atau) 2< !enadi $&siti#% A$a ini dise(ut L6T ) 2< !enadi $&siti#% A$a ini dise(ut L6T

aai!ana te"a$ina aai!ana te"a$ina


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27/115

ata$

RS/r

)-2 )0

,asi"

Ma" +

)-1

M"ai

O4at

)1

)2

);

)4

)> )= )*

)14 )21

)2<

K"iisMe!4rk

-K"iis !e!4rk-6 Parasit > 4a7ak

-K"iis !e!4rk-6 Parasit > 85 %-6 Parasit +& Te!p > (*95

MONITORING RESPONS DI RS/ PUSKESMAS RAWAT INAP

E9T9: ; G9O9ii L9T9: ; G9O9 La!4at

-K"iis !e!4rk-6 Parasit +& Te!p > (*95

- K"iis- !e!4rk-6 Parasit +

-K"iis !e!4rk-6 Parasit +&-Te!p > (*95

- K"iis- !e!4rk

-6 Parasit + - K"iis- !e!4rk-6 Parasit +

- K"iis- !e!4rk-6 Parasit +


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Panas0din$in

34C

alc0 rin$

34+ par/2++ *

!1 !2

0rin$

3+24/ 2++*

C 4/4/2 P3

!3

0rin$

115 par/2++*

Kina t6

3 7 3 t6/ 5 8ari

E.T.F

!5

Kasus Malaria Gagal Obat Dini

E.T.F


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*7 Fal$ip ring

/2leuk%

0( *27 Fal$ip ring2/2leuk%

*7 Fal$ip ring0/2leuk%

*1/ ,7 Fal$ip ring

9/2leuk%, SP1

*0/ ,17 Fal$ip ring19/2leuk%

*9/ ,87 Fal$ip ring

1 /2leuk%

*/ ,( 7 Fal$ip ring

2 /2leuk%

Temp 8C

:ina ; 2 tab

KASUS MALARIA

TANPA KOMPLIKASI

MULTI-DRUGS

RESISTANCE

,4. 159< $/d"

Leko . =

Tro!4o.259

'i".89*

reat . 1912


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Manae!ent T"eat!entManae!ent T"eat!ent

6ailu"es6ailu"es T"eat!ent #ailu"e Hithin 14 das De" T"eat!ent #ailu"e Hithin 14 das De"

unusual 3unusual 3;2 t"ials 4@1* $atients, n& #ailu"e &n 14;2 t"ials 4@1* $atients, n& #ailu"e &n 14* t"ials #ailu"e at 14 1 * ?* t"ials #ailu"e at 14 1 * ?6ailu"e a#te" 14 das 3 "e/"udes/ense &" "e-6ailu"e a#te" 14 das 3 "e/"udes/ense &" "e-

in#e/ti&nin#e/ti&nRes/ue t"eat!ent 3Res/ue t"eat!ent 3

Alte"natiDe ACT kn&Hn ee/tiDe in this "ei&nAlte"natiDe ACT kn&Hn ee/tiDe in this "ei&nA"tesunate 5 tet"a//lin: d&//line:A"tesunate 5 tet"a//lin: d&//line:

/linda!/in/linda!/inFuinine 5 tet"a//lin: d&//line: /linda!/inFuinine 5 tet"a//lin: d&//line: /linda!/in


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Lini keduaLini kedua

Kina 5 &ksisiklin: Tet"asiklin 5 P"i!akuinKina 5 &ksisiklin: Tet"asiklin 5 P"i!akuin


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!ari &enis o6at &umla8 ta6let menurut kelompok umur 9osis tun$$al +-11

6ulan1 - 4ta8un

' - :ta8un

1+ - 14ta8un

) 1'ta8un

1 Kina ;% 3 7 ½ 3 7 1 3 7 1 ½ 3 7 #2-3%

9oksisiklin -- -- -- 2 7 '+ m$ 2 7 1++ m$

Primakuin - 1 ½ 2 2 ( 3

2 - 5 Kina ;% 3 7 ½ 3 7 1 3 7 1 ½ 3 7 2

9oksisiklin -- -- -- 2 7 '+ m$ 2 7 1++ m$

9osis T?K*?@ -- -- -- 474 m$/k$""

4 7 2'+ m$

9osisC*?@9AMC?@

-- -- -- 271+ m$/k$""

271+ m$/k$""

Pen&(atan lini II alte"nati# k&!(inasi Kina 5 &ksisiklin: Tet"asiklin: Clinda!/in (ila aal $en&(atan lini I


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!ari &enis o6at &umla8 ta6let menurut kelompok umur

9osistun$$al

+ - 116ulan

1 - 4ta8un

' - :ta8un

1+ - 14ta8un

) 1'ta8un

1-5 Kina ;% 3 7 ½ 3 7 1 3 7 1 ½ 3 7 #2-3%

9oksisiklin -- -- -- 2 7 '+ m$ 2 7 1++ m$

1 - 14 Primakuin - ¼ ½ 1

9osisT?K*?@

-- -- -- 474 m$/k$""

4 7 2'+ m$

9osisC*?@9AMC?@

-- -- -- 271+m$/k$ ""

271+ m$/k$""

Pe$o4ata !"tiresiste ?i?a@/ o?a"e de$a ko!4iasi Kia +

oksisik"i/Tetrasik"i/"ida!7ci 4i"a $a$a" pe$o4ata "ii IB

P ( t M l i 9i k RELAPS


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Hari


Dosis

tunggal

0 – 1

bulan

2 – 11

bulan

1 - 4

tahun

5 - 9

tahun

10 - 14

tahun

> 15

tahun



Primakuin -- -- 1/2 1 11/2 2


Amodiakuin

Primakuin

¼

--

½

--

1

1/2

2

1

3

11/2

4

2

3

4-14


Amodiakuin

Primakuin

Primakuin

¼

--

½

--

1

1/2

1/2

2

1

1

3

1 1/2

1 1/2

4

2

2

Pen&(atan Mala"ia 9iDaks RELAPS


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Pen&(atan Mala"iaPen&(atan Mala"ia

Ca!$u"an Mied in#e/ti&n ,Ca!$u"an Mied in#e/ti&n ,

hal 20hal 20P% DiDaks dan P% #alsi$a"u!P% DiDaks dan P% #alsi$a"u!Lini $e"ta!a 3Lini $e"ta!a 3

A"tesunate 5 A!&diakuin 5 P"i!akuinA"tesunate 5 A!&diakuin 5 P"i!akuin

&sis P"i!akuin ha"i I 3 0%*> !:k :&sis P"i!akuin ha"i I 3 0%*> !:k :

sinle d&sesinle d&se

&sis PF ha"i 2 14 3 0,2> !:k &sis PF ha"i 2 14 3 0,2> !:k


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Hari


Dosis

tunggal

0 – 1

bulan

2 – 11

bulan

1 - 4

tahun

5 - 9

tahun

10 - 14

tahun

> 15

tahun



Primakuin -- -- 3/4 11/2 2 2-3


Amodiakuin

Primakuin

¼ ½ 1

1/4

2

1/2

3

3/4

4

1

3

4-14


Amodiakuin

Primakuin

Primakuin

¼ ½ 1

¼

1/4

2

½

1/2

3

3/4

4

1

1

Pen&(atan Mala"ia Ca!$u"an 9iDaks 5 6alsi$a"u! , hal


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)-P)-PHariHari %eis %eis

o5ato5at %umlah ta5let meurut kelompok umur %umlah ta5let meurut kelompok umur


( $ 8( $ 8

5ula5ula'' – –

8888 5ul5ul

aa

88 – – ))

tatahuhu

22 – – 99

tahtahuu

8(8( – – 8)8)

tahutahu

:: 8282

tahutahu

8$$;8$$; DHPDHP ¼¼ ½½ 88 832832 '' ; $ ); $ )

H8H8 PrimakuiPrimakui

$$$$ $$$$ 88 ½½ '' ' $ ;' $ ;

H'H' – – 8)8) PrimakuiPrimakui

$$ $$ ¼¼ ½½ 88Dihydroartemisinin(DH) : 2-4 mg/kgBB (1tablet = 40 mg)i!erak"in !hos!hate(): 1#-$2 mg/kgBB ( 1tablet = $20 mg)

rimak"in : 0&2 mg 0&' mg/kg BB


38/115

Case 1 ulCase 1 ul

20102010

G&!an, >* ea"s &ld, heada/he >G&!an, >* ea"s &ld, heada/he >

das, #eDe" and /&ld, a/hin Hh&ledas, #eDe" and /&ld, a/hin Hh&le

li!(s, e$iast"i/ $ain, nauseated%li!(s, e$iast"i/ $ain, nauseated%

7ell&H skin 1 Heek, da"k u"ine > das 7ell&H skin 1 Heek, da"k u"ine > das

LiDed in T&!(atu a"eaLiDed in T&!(atu a"ea

P% E 3 /&un/i&us, aundi/e, %P%P% E 3 /&un/i&us, aundi/e, %P%

1;0:


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La(&"at&" 3 )(% 12%; "?, )t ;=?, ESR 4>La(&"at&" 3 )(% 12%; "?, )t ;=?, ESR 4>

!!:1 h", leu/& %000% Mala"ia #al/i$% Rin 5555,O>000 $a": 200 GC, 21 $a": 1000 RC%O>000 $a": 200 GC, 21 $a": 1000 RC%

U"inalsis 3 ell&H, lu -, (il ;5, ket ne, S.U"inalsis 3 ell&H, lu -, (il ;5, ket ne, S.

1%01>, $) >%>, $"& ;5, u"& 0%2, nit -, leu 1%01>, $) >%>, $"& ;5, u"& 0%2, nit -, leu

ALT 10@, AST 144, P"&tein *%;, al( ;%


40/115


41/115

SE9ERE MALARIA -2010SE9ERE MALARIA -2010

9


42/115

MALARIA ERATMALARIA ERAT%&'&()& *+(+,(&'

%&'&()& D. ,)')(!,). > # %/&&' ).J&' &! " 400 ml24 3am reat > # mg/

H)6')+%) " 40 mg/

*76 *)*6') " 80 mmHg &nak " 50 mmHg

&.+%)& ,+(& H, " 5 gr/ Ht " 15/+D+%& &(! &(D*

+(D&(&H&. *6.&. D)

+J&. ,+(!'&.

&*)D6*)* h "8:15 ; lasma ,i


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PEN7EA : ETI+L+.IPEN7EA : ETI+L+.I

Plas!&diu! #al/i$a"u!Plas!&diu! #al/i$a"u!

Mied $las!&diu! 6al/i$a"u!5Mied $las!&diu! 6al/i$a"u!5

DiDaDiDa

Plas!&diu! DiDaPlas!&diu! DiDa

!las"o#iu" $nowlesi!las"o#iu" $nowlesi


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PLASM+IUM KN+GLESIPLASM+IUM KN+GLESI

Si!ian !ala"ia Ma//a/a !ullataSi!ian !ala"ia Ma//a/a !ullata Unusual $"esentati&n P% Mala"iaeUnusual $"esentati&n P% Mala"iae ian&sis ( PCRian&sis ( PCR A/ute dia"e, a(d&!inal $ain, aundi/eA/ute dia"e, a(d&!inal $ain, aundi/e

Alid !ala"ia, h$&tensi&nAlid !ala"ia, h$&tensi&n

Renal #ailu"e, "es$i"at&" #ailu"eRenal #ailu"e, "es$i"at&" #ailu"e


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M##=1M1* "1V1R1M##=1M1* "1V1R1

M#L#R-#M#L#R-# SPECI6IC TREATMENTSPECI6IC TREATMENT

ANTI MALARIAL RU.SANTI MALARIAL RU.S

+R.AN 6AILURE TREATMENT+R.AN 6AILURE TREATMENT SUPP+RTI9E TREATMENTSUPP+RTI9E TREATMENT

ANCILLAR7 TREATMENTANCILLAR7 TREATMENT


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ANTI MALARIAL THERAPY FOR S.MANTI MALARIAL THERAPY FOR S.M

FUININEFUININE

FUINIINEFUINIINE

A"tesunate: ARTS i%D%: i%! : su$$ A"tesunate: ARTS i%D%: i%! : su$$ A"te!ethe" : ARTM i%!%A"te!ethe" : ARTM i%!%

A"te-ethe" i%! A"te-ethe" i%!

A"te!isinin su$$ A"te!isinin su$$ ihd"&-a"te!isinin su$$ ihd"&-a"te!isinin su$$

A"telinate i%DA"telinate i%D


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"1V1R1 M#L#R-#"1V1R1 M#L#R-#

Re'ui"ed $a"ente"al &" su$$&ssit&"ia t"eat!entRe'ui"ed $a"ente"al &" su$$&ssit&"ia t"eat!ent e/"eased $a"asite!ia "a$idle/"eased $a"asite!ia "a$idl

Less side ee/tLess side ee/t

Fuinine Ds A"te!isinin ARTM , ARTS Fuinine Ds A"te!isinin ARTM , ARTS

ARTM t"end t& haDe l&H !&"talit (ut /&!aARTM t"end t& haDe l&H !&"talit (ut /&!a"e/&De" $"&l&n, !&"e /&nDulsi&n"e/&De" $"&l&n, !&"e /&nDulsi&n

ARTS ette" than Fuinine SEFUAMAT ARTS ette" than Fuinine SEFUAMAT


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9osis

R1!MM1D1D D"1" F #*- M#L#R-#L DR=" FRR1!MM1D1D D"1" F #*- M#L#R-#L DR=" FR

*R1#*M1* F "1V1R1 M#L#R-#*R1#*M1* F "1V1R1 M#L#R-#

i%D% 2,4 !:k $ada a! 0, dani%D% 2,4 !:k $ada a! 0, dan a! 12, ke!udian dilanutkan a! 12, ke!udian dilanutkan a! 24, 4< dst sa!$ai * ha"i% a! 24, 4< dst sa!$ai * ha"i%&sis t&tal 1* 1< !: * ha"i&sis t&tal 1* 1< !: * ha"i 1 A!$ =0 ! 1 A!$ =0 !

;%2 !:k i! $ada ha"i I di(ai 2;%2 !:k i! $ada ha"i I di(ai 2d&sis, dilanutkan 1%= !:k:d&sis, dilanutkan 1%= !:k:ha"i% TIAK iD 1 a!$


49/115

Dosis ARTEMISININ PADA MALARIADosis ARTEMISININ PADA MALARIABERAT BERAT

# ARTEMETER $ %an&a I.M $ 'osis ($) *g"+g BB

ARTESUNATE


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ARTESUNATE

I.V / I.M

1 6l =0 !

ARTEMETHER I.M1 A!$


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SEFUAMAT

9S

AFUAMAT

% 2005, &ancet, 'gst (

%2010, &ancet, )o* (

S&uth East-asia FUinine A"tesunateMala"ia T"ial

A#"i/a Funine A"tesunate

Mala"ia T"ial


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P#=F/ 'ag. Pen(akit Dalam

F: B>R!T/ R>BP =anad%

R>B 'et)esda -T%m%)%n

Telp.7

1-021/19 R>B 'et)esda&

82-1-289 *P& 1-08 Res&

E-mail 7 paul)ariant%gmail.$%m

Sa"+ai a$u a+a


53/115

M+RTALIT7

0%1? /ase #atalit "ate $"&Dided$"&!$t and ee/tiDe t"eat!ent

Inee/tiDe, delaed seDe"e!ala"ia

SeDe"e !ala"ia, !&"talit 1> 20 ?

Unt"eated seDe"e !ala"ia, al!&stalHas #atal


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TREATMENT +JECTI9ES

Un/&!$li/ated !ala"ia 3 Cu"e in#e/ti&n P"eDent $"&"essi&n seDe"e disease P"eDent !&"(idit ass&/iated Hith t"eat!ent

#ailu"e Redu/ed t"ans!issi&n P"eDent the e!e"en/e 8 s$"ead "esistan/e

anti!ala"ial

SeDe"e Mala"ia 3 P"eDent death P"eDenti&n "e/"udes/en/e AD&iden/e !in&" adDe"se ee/ts


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>>>>

ase 1:

*aki-laki0 31 ta8un0 peker,a tam6an$ emas di !alma8era

#IosoDo% masuk =>0 31 Bkto6er 2++: den$an kelu8an PA@A>

9?@I?@0 4 8ari se6elum masuk => *ima 8ari se6elumnGa pasien ,u$a merasa sakit perut06a6 cair 170 =iDaGat PenGakit 9a8ulu L

>eptem6er 2++: Malaria FiJa7 di !alma8era dio6ati Klorouin 2-

2-1 dan Primakuin 172 ta6let selama 14 8ari

Pemeriksaan Fisik : >adar0 T9 13+/+mm!$0 nadi :.7/menit0su8u 4+NC0 tidak tampak anemia0 >clera tidak icteric &antun$

dan Paru dalam 6atas normal A6domen supel0nGeri tekan

epi$astrium#%0 8epar dan lien tidak tera6a mem6esar0 timpani0

6isin$ usus normal Hasil Laoratorium: !6 131 $r0 !t 3:L

*euko 41++/mm30 Trom6osit 41+++/mm30 Plasmodium JiJa7 rin$

!ia"nosa #er$a :OOOOOOO

ISKUSI


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>=>=

ISKUSI 31%.eala de!a! 8 dia"e 3 .eala n&n-klasik 2%Plas!&diu! 9iDa Rin 555 , satu (ulanse(elu!na DiDa $&s% Rela$s : Re-/"udensi : Re-in#eksi

;% )asil La(&"at&"iu! 3 T"&!(&sit&$enia 41%000: !!;% Se"in didian&se enue A$a na

4% Pen&(atan Mala"ia se(elu!na denan 3CF 5 PF 2 t(:14 ha"i% A$a $en&(atan

an (ena"


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Pene(a( T"&!(&sit&$eniaPene(a( T"&!(&sit&$enia

e#e/ts the !a""&He#e/ts the !a""&H

Se'uest"ati&n due t& s$len&!ealSe'uest"ati&n due t& s$len&!eal

A//ele"ated dest"u/ti&n 3A//ele"ated dest"u/ti&n 3In#e/ti&ns denue, !ala"ia, t$h&id,In#e/ti&ns denue, !ala"ia, t$h&id,

"a! ne "a! ne

"us"usAut&i!!uneAut&i!!une

>*>*


58/115

ian&saian&sa

andin 3andin 3

!6 131 $r0 !t 3:L *euko 41++/mm30!6 131 $r0 !t 3:L *euko 41++/mm30

Trom6osit 41+++/mm3 9en$ue infection Trom6osit 41+++/mm3 9en$ue infection

><

'andingkan kasus ini 7

*ari ?. *b 9 gr6, *t 006, Leuk% 1, Tr%mb% .*ari ?? 7 *b, 0.0 gr6, *t 06, Tr%mb% .

*ari ???7 *b 1.0 gr6, *t 16, Tr%mb% 2.

*ari ?7 *b 1.0 gr6, *t 196, Tr%mb% 2.

* t l Ai di i t t ti li t d*emat%l%g Aindings in a$ te s mpt%mati$ n$%mpli$ated


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*emat%l%g( Aindings in a$ute s(mpt%mati$ un$%mpli$ated*emat%l%g( Aindings in a$ute s(mpt%mati$ un$%mpli$ated

P.falciparumP.falciparum malaria patients %n admissi%n "9&malaria patients %n admissi%n "9&

!nemia 6&!nemia 6& 7 7 9.&9.&*em%gl%bin7 means range&g/dl 7 2.*em%gl%bin7 means range&g/dl 7 2. 9. - 0.8&9. - 0.8&

Er(t)r%$(te7 means range&/ul in milli%nEr(t)r%$(te7 means range&/ul in milli%n 7 1.27 1.2 2.9 G0.&2.9 G0.&

Leuk%$(te7 means range&/ulLeuk%$(te7 means range&/ul 7 0,8 2,9 G ,2&7 0,8 2,9 G ,2&Platelet7 means range&/ul in t)%usandPlatelet7 means range&/ul in t)%usand 7 27 2 0 G 2&0 G 2&


60/115

PEN.+ATAN 3PEN.+ATAN 3

CF; 5 PF 2 ta(;0!: ha"i , 14 ha"iCF; 5 PF 2 ta(;0!: ha"i , 14 ha"i

Pen&(atan an (ena" Pen&(atan an (ena"

=0=0



61/115


The 6i#th Mala"ia The 6i#th Mala"iaulu hana !enin#eksi ke"a Ma/a/a Mullataulu hana !enin#eksi ke"a Ma/a/a Mullata Seak th 2004 dila$&"kan "et"&s$eksi# di Se"aHakSeak th 2004 dila$&"kan "et"&s$eksi# di Se"aHak9e/t&" An&$heles leu/&s$h"us "&u$ An% Laten,9e/t&" An&$heles leu/&s$h"us "&u$ An% Laten,

/"a/ens/"a/ensMisdian&sis se(aai !ala"ia !ala"iae,Misdian&sis se(aai !ala"ia !ala"iae,!ik"&sk&$ik !ene"u$ai P% !ala"iae!ik"&sk&$ik !ene"u$ai P% !ala"iae

Klinis TIAK se$e"ti !ala"iaeKlinis TIAK se$e"ti !ala"iae, de!a! tia$ 24 a!,, de!a! tia$ 24 a!,

dia"ea, ne"i a(d&!en dan dite!ukandia"ea, ne"i a(d&!en dan dite!ukanhi$e"$a"asite!ia O 2>0%000:uLhi$e"$a"asite!ia O 2>0%000:uLa$at !e!(e"ikan k&!$likasi ikte"ik, hi$&tensi,a$at !e!(e"ikan k&!$likasi ikte"ik, hi$&tensi,

aal inal, se"e("al dan aal $e"na#asanaal inal, se"e("al dan aal $e"na#asan

ian&sa $asti identikasi denan PCRian&sa $asti identikasi denan PCR


62/115

Mala"ia Kn&Hlesi

IA.N+SISIA.N+SIS


63/115

IA.N+SISIA.N+SISP"esentasi Klinis e"Da"iasiP"esentasi Klinis e"Da"iasi

.eala e!a! se"in dikeli"ukan denan.eala e!a! se"in dikeli"ukan denanin#eksi lain Ti#&id, enue,in#eksi lain Ti#&id, enue,

Le$t&s$i"&sis, Chinkukuna, ISPA Le$t&s$i"&sis, Chinkukuna, ISPA

K&!$likasi $enu"unan kesada"an, se"inK&!$likasi $enu"unan kesada"an, se"indikeli"ukan denan !eninitis,dikeli"ukan denan !eninitis,

ense#alitis, ense#al&$ati lainnaense#alitis, ense#al&$ati lainna

Jaundi/e:ikte"ik se"in didian&sis Jaundi/e:ikte"ik se"in didian&sisse(aai he$atitis atau k&lesistitisse(aai he$atitis atau k&lesistitis

ETEKSI PARASIT MIKR+SK+PIK atauETEKSI PARASIT MIKR+SK+PIK atau

RT RT


64/115


65/115

Go"o$a ARTEMISININGo"o$a ARTEMISININ


66/115

Go"o$a ARTEMISININGo"o$a ARTEMISININArte!isii& Artesate& Arte!etCer& ArteetCer& ,AArte!isii& Artesate& Arte!etCer& ArteetCer& ,A

H DD0i$Caos F Sesiterpee Lactoe0i$Caos F Sesiterpee Lactoe

H Lart da"a! air da dia4sor4si 4aikLart da"a! air da dia4sor4si 4aik

H E-ek 4C parasit 7a$ cepatE-ek 4C parasit 7a$ cepat

H epat diko?ersi ke 4aCa akti- ,ABepat diko?ersi ke 4aCa akti- ,AB

H tt1/81/8 i !a"aria. 8 Corsi !a"aria. 8 Cors

H Spektr! 7a$ "as tk se!a Heis parasit daSpektr! 7a$ "as tk se!a Heis parasit da

sta$i$sta$i$H 'i"a dipakai !ootCerap7& per" * Cari'i"a dipakai !ootCerap7& per" * Cari

H ireko!edasika pe$$aa ATireko!edasika pe$$aa AT

A t i i i ( C (i tiA"te!isinin (ase C&!(inati&n


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A"te!isinin-(ase C&!(inati&nA"te!isinin-(ase C&!(inati&n

The"a$ A%C%T The"a$ A%C%TRa$id /le"an/e $a"asitesRa$id /le"an/e $a"asites

Ra$id "es&luti&n s!$t&!sRa$id "es&luti&n s!$t&!s

Redu/e $a"asites ( 10%000://le $astRedu/e $a"asites ( 10%000://le $ast

anti!ala"ial &nl 100-1000 $a"asites:anti!ala"ial &nl 100-1000 $a"asites://le//le

Eli!inated "a$idl3Eli!inated "a$idl3 Hhen iDen t& "a$id d"u eli!inati&n, sh&uldHhen iDen t& "a$id d"u eli!inati&n, sh&uld

iDe &n * dasiDe &n * das

Ghen iDen /&!( Hith sl&H eli!inated, sh&"te"Ghen iDen /&!( Hith sl&H eli!inated, sh&"te"

/&u"se t"eat!ent ; das a"e ee/tiDe /&u"se t"eat!ent ; das a"e ee/tiDe

h =i l? & bi tih =i l? & bi ti


68/115

he =ieal? & upplG o6at cukup


69/115

URRENT APPROA, MALARIA TREATMENTURRENT APPROA, MALARIA TREATMENT

'ased o !icroscopic dia$osis'ased o !icroscopic dia$osis o!4iatio tCerap7o!4iatio tCerap7Mst radica" treat!etMst radica" treat!et Otco!e -ocs o c"iica" cre& parasito"o$ica"Otco!e -ocs o c"iica" cre& parasito"o$ica"

c"earace& ad 4"ocki$ tras!issioc"earace& ad 4"ocki$ tras!issioMoitori$ tCerapetic e--icac7 ati!a"aria" dr$s 4asedMoitori$ tCerapetic e--icac7 ati!a"aria" dr$s 4ased

o c"iica" ad parasito"o$ica" resposes o c"iica" ad parasito"o$ica" resposes in-vivoin-vivo 8


70/115

Re/&!!endati&n G)+Re/&!!endati&n G)+

20102010in usin ACTs 3in usin ACTs 3

A"te!ethe"-lu!e#ant"ine AL A"te!ethe"-lu!e#ant"ine AL

A"tesunate 5 a!&dia'uine AS 5 AF A"tesunate 5 a!&dia'uine AS 5 AF A"tesunate 5 !eQ&'uine AS 5 MF A"tesunate 5 !eQ&'uine AS 5 MF

A"tesunate 5 sul#ad&ine-$"i!etha!ineA"tesunate 5 sul#ad&ine-$"i!etha!ine

AS 5 S-P AS 5 S-P ihd"&a"te!isinin Pi$e"a'uine )A-ihd"&a"te!isinin Pi$e"a'uine )A-

PPF PPF

Pen&(atan Mala"ia $adaPen&(atan Mala"ia $ada


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Pen&(atan Mala"ia $adaPen&(atan Mala"ia $ada

keha!ilankeha!ilan

Pakai &(at an e#ekti# Pakai &(at an e#ekti# Pe"ti!(ankan kea!anan &(at untukPe"ti!(ankan kea!anan &(at untuk

keha!ilankeha!ilan

PENTIN. 3PENTIN. 3e"atna $enakit Mala"iae"atna $enakit Mala"iaP&la "esitensi $en&(atanP&la "esitensi $en&(atan

A$a &(at an a!anA$a &(at an a!anACT untuk t"i!este" 2 8 ; A-L 8 A"s5MACT untuk t"i!este" 2 8 ; A-L 8 A"s5MKina )Cl denan: tan$a /linda!/inKina )Cl denan: tan$a /linda!/in


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i"th &ut/&!esi"th &ut/&!es

Pen&(atan u!il Tan$aPen&(atan u!il Tan$a


73/115

Pen&(atan u!il Tan$aPen&(atan u!il Tan$a

k&!$likasi e$Kesk&!$likasi e$KesPlas!&diu! 6alsi$a"u! 3Plas!&diu! 6alsi$a"u! 3ACT A"s 5 A!&, tan$a P', T"i!este" 2ACT A"s 5 A!&, tan$a P', T"i!este" 2

-;-;

Kina ; 2-; t(, tan$a P', T"i!este" 1Kina ; 2-; t(, tan$a P', T"i!este" 1atau aal ACT Kina 5 Clinda!/in 2 atau aal ACT Kina 5 Clinda!/in 2

10 !:k : * ha"i10 !:k : * ha"i

Plas!&diu! 9iDaks 3Plas!&diu! 9iDaks 3Kl&"&'uin 4:4:2 t( , tan$a $"i!akuinKl&"&'uin 4:4:2 t( , tan$a $"i!akuin

Pen&(atan u!il Mala"iaPen&(atan u!il Mala"ia


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Pen&(atan u!il Mala"iaPen&(atan u!il Mala"ia

e"ate"at

T"i!este" 2 -; , du"ante: $&st $a"tu! 3 T"i!este" 2 -; , du"ante: $&st $a"tu! 3A"tesunate i%D 2,4 !:k a! 0, 12,A"tesunate i%D 2,4 !:k a! 0, 12,

24, 4< dst, (ila sada": (isa !inu!24, 4< dst, (ila sada": (isa !inu!

&(at anti &"al sa!$ai > * ha"i% ila&(at anti &"al sa!$ai > * ha"i% ila

&"al a"tesunate 2 !:k di(e"ikan&"al a"tesunate 2 !:k di(e"ikansa!$ai ha"i ke-* a"s 5 /linda!/insa!$ai ha"i ke-* a"s 5 /linda!/in

T"i!este" 1 3 Kina )Cl $e"in#us, 20 T"i!este" 1 3 Kina )Cl $e"in#us, 20

!:k d&sis aHal dan 10 !:k !:k d&sis aHal dan 10 !:k selanutnaselanutna


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76/115


77/115

hal% ;1

r$sr$s Ta4 siJeTa4 siJe Ad"tAd"t Ci"dCi"d Pre$Pre$ IitiateIitiate iscotiediscotied

9ru$ re$imens for prop8Gla7is a$ainst malaria


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r$sr$s Ta4 siJeTa4 siJe

mgmgAd"tAd"t

dosedoseCi"dCi"d Pre$Pre$ IitiateIitiate iscotiediscotied

Areas itC C"oroie F resistat :a"cipar!Areas itC C"oroie F resistat :a"cipar!

!t%@a#u%ne-!t%@a#u%ne-Pr%guanilPr%guanil

20-20-92.0-2092.0-20

11tb/dtb/d IesIes %% -2 d-2 d da(s da(s

=eAl%#uine *Cl=eAl%#uine *Cl 2020 11tb/Jtb/J IesIes IesIes Jks Jks 1 Jks1 Jks

o@7c7c"ieo@7c7c"ie 11 11t4/dt4/d NoNo NoNo 168 d168 d 2 ks2 ks

Areas itC C"oroie6 sesiti?e :a"cipar!Areas itC C"oroie6 sesiti?e :a"cipar!

C)l%r%#uineC)l%r%#uine 00 tb/Jtb/J IesIes IesIes Jk Jk 1 Jks1 Jks

Areas itC P9 ?i?a@& P o?a"e itC/ itCot P9 :acipar!Areas itC P9 ?i?a@& P o?a"e itC/ itCot P9 :acipar!

Prima#uinePrima#uine

primar(primar(

00 22

tb/dtb/d

IesIes %% Jk Jk 1 Jks1 Jks

Prima#uinePrima#uine

!nti-relaps!nti-relaps

00 22

tb/dtb/d

IesIes %% da( da( da(s da(s

engobatan ina Hli-hiroklori parenteralengobatan ina Hli-hiroklori parenteral


79/115

00 44 $$ 1212 1@1@ 2020 2424

'oaing'oaing

20 mgkg,, )A inBus100-200 ml4 3am20 mgkg,, )A inBus100-200 ml4 3am

,erat baan C: g,erat baan C: g

ak pakai ina%eBlouin 24 3am sebelumnEaak pakai ina%eBlouin 24 3am sebelumnEa

iak lan3ut usia atau FF< int: pan3angiak lan3ut usia atau FF< int: pan3ang

10 mgkg,,10 mgkg,,

)A inBus 200 ml4 3am)A inBus 200 ml4 3am

iulang tiap $ 3amiulang tiap $ 3am)nBus kosong $ 3am)nBus kosong $ 3am

Gtanpa kinaGtanpa kina

)nBus kosong $ 3am)nBus kosong $ 3am

Gtanpa kinaGtanpa kina

I&! GJ&%I&! GJ&%

*tanar*tanar

10 mgkg,, )A10 mgkg,, )A

inBus200 ml4 3aminBus200 ml4 3am

SETELAH KESADARAN MEMBAIK/DAPAT MINUM :SETELAH KESADARAN MEMBAIK/DAPAT MINUM :

GANTI PER-ORAL 10 MG/KGBB/8 JAMGANTI PER-ORAL 10 MG/KGBB/8 JAM

SAMPAI HARI KE-7SAMPAI HARI KE-7

APABILA SETELAH 48 JAMAPABILA SETELAH 48 JAM

KEADAAN TIDAK MEMBAIK :KEADAAN TIDAK MEMBAIK :

GCS TETAP/MEMBURUK GCS TETAP/MEMBURUK

BILIRUBIN / KREATININ NAIK BILIRUBIN / KREATININ NAIK

URIN KURANG / TAK ADAURIN KURANG / TAK ADA

DOSIS DITURUNKAN 30-50%DOSIS DITURUNKAN 30-50%

10 mgkg,,10 mgkg,,

)A inBus 200 ml4 3am)A inBus 200 ml4 3am


80/115

9e7trose '

Kina

Microdrips

1++-2++ cc

Pi$$G

"ackCairan

Maintenance

!#R# P1M>1R-#!#R# P1M>1R-#

1R#*

engobatan ina Hli-hiroklori parenteralengobatan ina Hli-hiroklori parenteral


81/115

00 44 1212 1@1@ 2020 2424

I&! GJ&%I&! GJ&%

500 mg ina Hl G1 amp500 mg ina Hl G1 amp

alam 500


82/115

Penesuaian d&sis $ada anuan 6unsi +"ane esua a d&s s $ada a ua u s + a

Ti'a+ ,-rlu ,-n&-suaian 'osis obat '-riat art-*isininTi'a+ ,-rlu ,-n&-suaian 'osis obat '-riat art-*isinin,a'a gangguan /ungsi %ati 'an atau gin0al,a'a gangguan /ungsi %ati 'an atau gin0al Dosis +ina ,ar-nt-ral 'iturun+an ("1 s-t-la% 23 0a*Dosis +ina ,ar-nt-ral 'iturun+an ("1 s-t-la% 23 0a*

,-*b-rian ,a'a 4,-*b-rian ,a'a 4 Gagal gin0al a+utGagal gin0al a+ut Gangguan /ungsi %atiGangguan /ungsi %ati Ti'a+ a'a ,-rbai+an +linis s-t-la% 23 0a*Ti'a+ a'a ,-rbai+an +linis s-t-la% 23 0a* Bila ,asi-n su'a% %-*o'ialisis ti'a+ ,-rluBila ,asi-n su'a% %-*o'ialisis ti'a+ ,-rlu

,-ngurangan 'osis +ina,-ngurangan 'osis +ina

( l P ( t l t


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Pen&(atan lanutanPen&(atan lanutan S-t-la% ,asi-n sa'ar"K *-*bai+$ t5. A6al ,ar-nt-ralS-t-la% ,asi-n sa'ar"K *-*bai+$ t5. A6al ,ar-nt-ral

'a,at 'iuba% 'gn. T5. Oral'a,at 'iuba% 'gn. T5. Oral Dit-rus+an '-ngan 4Dit-rus+an '-ngan 4 A7T 'osis l-ng+a, 8s-la*a 1 %ari94 AL $ AS : A;A7T 'osis l-ng+a, 8s-la*a 1 %ari94 AL $ AS : A; Art-sunat-"art-*-t%-r tab. 8total < %ari 9 : 'o+sisi+lin 1=Art-sunat-"art-*-t%-r tab. 8total < %ari 9 : 'o+sisi+lin 1=

> Kg BB ( +ali s-%ari s-la*a < %ari> Kg BB ( +ali s-%ari s-la*a < %ari Kina tab.8total < %ari9 : 'o+sisi+lin < %ariKina tab.8total < %ari9 : 'o+sisi+lin < %ari Bagi bu*il$ ana+=ana+ 4 'o+sisi+lin 'iganti '-nganBagi bu*il$ ana+=ana+ 4 'o+sisi+lin 'iganti '-ngan

+lin'a*isin (? *g"Kg BB @ +ali s-%ari+lin'a*isin (? *g"Kg BB @ +ali s-%ari


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Pen&(atan $"e-"e#e"alPen&(atan $"e-"e#e"al

ianu"kan se(elu! !e"uuk setidaknaianu"kan se(elu! !e"uuk setidaknad&sis $e"ta!a &(at anti!ala"ia $a"ente"ald&sis $e"ta!a &(at anti!ala"ia $a"ente"alsudah di(e"ikan%sudah di(e"ikan%

+(at an di$ilih 3+(at an di$ilih 3 A"te!ethe" i%!% atau A"tesunate i%!%A"te!ethe" i%!% atau A"tesunate i%!% A"tesunate atau a"te!isinin su$&sit&"iaA"tesunate atau a"te!isinin su$&sit&"ia

Kina i%!%Kina i%!% Kina i%D% dida!$ini $etuas !edis Kina i%D% dida!$ini $etuas !edis

Case Jul 200>Case Jul 200>


85/115

J J

P"ia, >; th, de!a! > ha"i se(elu! MRS, !eniil, sakitP"ia, >; th, de!a! > ha"i se(elu! MRS, !eniil, sakitke$ala, (e"ke"inat, ne"i ulu hati, (adan kunin%ke$ala, (e"ke"inat, ne"i ulu hati, (adan kunin%

i"uuk da"i PKM dn dian&sa !ala"ia DiDa denani"uuk da"i PKM dn dian&sa !ala"ia DiDa denan!elena, Se(elu! (e"&(at di PKM di&(ati &leh (idan!elena, Se(elu! (e"&(at di PKM di&(ati &leh (idan%%Pende"ita ua !eneluh dia"ea ; h" se( ke RS, di&(atiPende"ita ua !eneluh dia"ea ; h" se( ke RS, di&(atidenan CF 4:4:2denan CF 4:4:2

P% 6isik 3 kesada"an (aik, tensi @0:=, nadi 100 : !enit,P% 6isik 3 kesada"an (aik, tensi @0:=, nadi 100 : !enit,"es$ 24:!enit, te!$ ;@C, ane!is 5, ikte"us 5% Jantun"es$ 24:!enit, te!$ ;@C, ane!is 5, ikte"us 5% Jantundan $a"u n&"!al% )e$at&!eali, lien tak te"a(a%dan $a"u n&"!al% )e$at&!eali, lien tak te"a(a%

ian&sa 3 Mala"ia e"atian&sa 3 Mala"ia e"at

La(&"at&"iu! 3 )( @,> "?, leuk& 4*00, t"&!(&La(&"at&"iu! 3 )( @,> "?, leuk& 4*00, t"&!(&1*%000, di% leuk& 3 -:-:2=:42:;0:2, LE 40, )t 2


86/115

La(&"at&"iu!La(&"at&"iu!U"eu! 20> !:dl, /"eatinin ;,1= !:dl, (ili"u(inU"eu! 20> !:dl, /"eatinin ;,1= !:dl, (ili"u(in

t&tal >,@ !:dl di"ek ;,< !:dl, AST 2>;t&tal >,@ !:dl di"ek ;,< !:dl, AST 2>;

u:dl, ALT


87/115

P#=F/ 'ag. Pen(akit Dalam

F: B>R!T/ R>BP =anad%

R>B 'et)esda -T%m%)%n

Telp.7

1-021/19 R>B 'et)esda&

82-1-289 *P& 1-08 Res&

E-mail 7 paul)ariant%gmail.$%m

Sa"+ai a$u a+a

TREATMENT +6 +R.AN 6AILURETREATMENT +6 +R.AN 6AILURE


88/115

TREATMENT +6 +R.AN 6AILURE TREATMENT +6 +R.AN 6AILURE

1!1PH#LP#*H,/ !VL"-1!1PH#LP#*H,/ !VL"-R1#L F#-LR1R1#L F#-LR1

R1"P-R#*R, F#-LR1R1"P-R#*R, F#-LR1

#!-D"-"#!-D"-"H,P=L,!#1M-#H,P=L,!#1M-#

H,P1R>-L-R>-#1M-#H,P1R>-L-R>-#1M-#

H,P*1"-H,P*1"-

"1P"-""1P"-"

"1V1R1 ##1M-#"1V1R1 ##1M-#

A 2


89/115

+n @ Se$te!(e" 2002 at 10%00 a%!%

Falcip ? +gamet

H5. 8'.;>l. "ugar ?8(2 mg@

>ill. Dir? A.B>ill.idir? 8."=* ?8B' u"=P* ? 8(9u

==* ? )C u/L#l.P)? ;A9!reat ? 8.2 pH ? B.)H!; ? ';.Cp' ? C(p!'? ;B>.1x.?$ (.9< ? ;.'!"F ?!ell E '((L&mph. ?9)

-


90/115

7-r-bral Malaria 6it% in/iltrat- bot% lungMM1-;

!hest$ra&

8C hours#fteradmissio


91/115

23 %ours a/t-r uinin- tr-at*-nt MM1-4

CLINICAL MANI6ESTATI+NCLINICAL MANI6ESTATI+N


92/115

CMCMNEUROLOGIAL SNROME . I::USE& POTENTIALLNEUROLOGIAL SNROME . I::USE& POTENTIALL

RAPIL REERSI'LE ENEP,ALOPAT, ASSOIATERAPIL REERSI'LE ENEP,ALOPAT, ASSOIATE

IT, LOSS O: ONSIOUSNESS AN :ITTINGIT, LOSS O: ONSIOUSNESS AN :ITTING

mild meningism, n% ne$k rigidit(mild meningism, n% ne$k rigidit(

d(s$%nugate gaKed(s$%nugate gaKe

@erti$al n(stagmus@erti$al n(stagmus

.? pals(.? pals(

d%lls e(e, %$ul%@estibular reAle; n%rmal resp%nsed%lls e(e, %$ul%@estibular reAle; n%rmal resp%nse

s(metri B=, in$reased t%ne 4 erk, $l%nus, e;tens%rs(metri B=, in$reased t%ne 4 erk, $l%nus, e;tens%r plantar resp%nse + , brisk


93/115

Respo mataRespo mata ? spota? spota ))dg suaradg suara ;;

dg &eridg &eri ''tak ada reaksitak ada reaksi 88

Respo >icaraRespo >icara ? ormal respo? ormal respo 225igug5igug ))

5erkata kacau5erkata kacau ;;suara meritihsuara meritih ''tak ada suaratak ada suara 88

Respo motorik? geraka ormalRespo motorik? geraka ormal AA

dapat melokalisir &eridapat melokalisir &eri 22eksi thdp &erieksi thdp &eri ))extesiextesi ;;decere5rate rigidit&decere5rate rigidit& ''tak ada reaksitak ada reaksi 88

TOTAL ( 66 15

'"at7re o!a Sca"e !odi-ikasiB'"at7re o!a Sca"e !odi-ikasiB


94/115

7 B7 B

Respo mataRespo mata ??

megikuti GaIah i5umegikuti GaIah i5u 88tak ada reaksitak ada reaksi ((

Respo >icaraRespo >icara ??

meagis GaIarmeagis GaIar ''

meagis meritihmeagis meritih 88

tak ada suaratak ada suara((

Respo motorik Respo motorik ??

melokalisir &erimelokalisir &eri ''

mearik aggota o.k. &erimearik aggota o.k. &eri 88

tak ada reaksitak ada reaksi ((

TOTAL 66*

ACUTE KINE7 INJUR7 AKIACUTE KINE7 INJUR7 AKI


95/115

Mala"ia "elated A/ute Kidne Inu" MAKIMala"ia "elated A/ute Kidne Inu" MAKI

Penu"unan #unsi inal dala! 4< a! 3Penu"unan #unsi inal dala! 4< a! 3Peninkatan se"u! k"eatinin 0%; !:dL, atauPeninkatan se"u! k"eatinin 0%; !:dL, atau

Peninkatan se"u! k"eatinn >0? dan nilaiPeninkatan se"u! k"eatinn >0? dan nilai

dasa", ataudasa", atauPenu"unan u"in &ut$ut 0%> !l:k:a! untuk =Penu"unan u"in &ut$ut 0%> !l:k:a! untuk =

a! a!

G)+ 3 se"u! k"eatinin O ; !:dLG)+ 3 se"u! k"eatinin O ; !:dL

Se"in $ada !ala"ia deHasa dan a"anSe"in $ada !ala"ia deHasa dan a"an

$ada anak$ada anak

ACUTE RENAL 6AILURE IN SE9ERE MALARIAACUTE RENAL 6AILURE IN SE9ERE MALARIA


96/115

ACUTE RENAL 6AILURE IN SE9ERE MALARIAACUTE RENAL 6AILURE IN SE9ERE MALARIA

PRE-RENAL RENAL

U!"# S$G 1$0&0 '1$010

U!"# O()$ 500 '350

*)O()/+, H&O

U!"# N. *)#/L '10 &0P.(). BUN/C#.!"!"# 15:1 '10-15:1

U/P U#. &0:1 '10:1

U/P C#.!"!"# 40:1 '10:1

U/P O()2.! &:1 '1:1

R#". .!# I"6# '1 1

.9!2". #9#!2" 2

!##6 N. '1 1

PULM+NAR7 MANI6ESTATI+N IN MALARIAPULM+NAR7 MANI6ESTATI+N IN MALARIA


97/115

)ist&"i/all 3)ist&"i/all 3"&n/hiti/"&n/hiti/

Pneu!&ni/Pneu!&ni/

"&n/h&$neu!&ni/"&n/h&$neu!&ni/A/ute Lun Inu" ALIA/ute Lun Inu" ALI

A/ute Res$i"at&" ist"essA/ute Res$i"at&" ist"ess

Snd"&!e ARSSnd"&!e ARS

A R SA%R%%S


98/115

A%R%%SA%R%%S

+//u"s in P% 6al/i$a"u!, P% 9iDa, P% +Dale 8 P%+//u"s in P% 6al/i$a"u!, P% 9iDa, P% +Dale 8 P%Kn&HlesiKn&Hlesi

C&!!&n in adult than /hild"en, $"enan/ andC&!!&n in adult than /hild"en, $"enan/ and

n&n-i!!unen&n-i!!une

Me/hanis! 3 In/"eased alDe&la" /a$$ila"Me/hanis! 3 In/"eased alDe&la" /a$$ila"$e"!ea(ilit$e"!ea(ilit int"aDas/ula" Quid l&ss int& theint"aDas/ula" Quid l&ss int& the

lunsluns

P"esentati&n 3 initial $"esentati&n &" a#te" initiati&nP"esentati&n 3 initial $"esentati&n &" a#te" initiati&n

t"eat!entt"eat!entClini/al 3 a/ute &nset ds$neaClini/al 3 a/ute &nset ds$nea "es$i"at&" #ailu"e"es$i"at&" #ailu"e

CLINICAL 6ININ.CLINICAL 6ININ.


99/115

CLINICAL 6ININ.CLINICAL 6ININ. Mani#est a("u$t &nset ds$n&ea, /&uh, tihtness inMani#est a("u$t &nset ds$n&ea, /&uh, tihtness in

the /hest that $"&"esses "a$idl &De" a #eH h&u"sthe /hest that $"&"esses "a$idl &De" a #eH h&u"s is&"ientati&n and aitati&n is #"e'uentl $"esent%is&"ientati&n and aitati&n is #"e'uentl $"esent%

Phsi/al ea!inati&nPhsi/al ea!inati&n 3 sins "es$i"at&" dist"ess ai"3 sins "es$i"at&" dist"ess ai"

hune", use a//ess&" !us/les "es$i"ati&n,hune", use a//ess&" !us/les "es$i"ati&n,

su$"aste"nal and inte"/&stal ind"aHin , /ent"al andsu$"aste"nal and inte"/&stal ind"aHin , /ent"al and$e"i$he"al /an&sis a"te"ial h$&ae!ia, (asal$e"i$he"al /an&sis a"te"ial h$&ae!ia, (asal

/"e$itati&ns and e$i"at&" Hheein%/"e$itati&ns and e$i"at&" Hheein%

In these $atients, hih $a"asitae!ia,a/ute "enal #ailu"e,In these $atients, hih $a"asitae!ia,a/ute "enal #ailu"e,

h$&l/e!ia, !eta(&li/ a/id&sis, disse!inatedh$&l/e!ia, !eta(&li/ a/id&sis, disse!inatedint"aDas/ula" /&aulati&n IC, and (a/te"ial se$sisint"aDas/ula" /&aulati&n IC, and (a/te"ial se$sis

usuall /&-eist%usuall /&-eist%

Chest "adi&"a$h 3Chest "adi&"a$h 3


100/115

Chest "adi&"a$h 3 $ ilate"al #"&ntal &$a/ities alDe&la"ilate"al #"&ntal &$a/ities alDe&la"

$atte"n, in/"eased inte"stitial !a"kins$atte"n, in/"eased inte"stitial !a"kins The /a"dia/ sie is usuall n&"!al The /a"dia/ sie is usuall n&"!al

Ra"el, thi/kenin lun ssu"es,Ra"el, thi/kenin lun ssu"es,

inte"l&(ula" se$tal linesinte"l&(ula" se$tal lines

Pleu"al eusi&nPleu"al eusi&n

In assisted Dentilat&" 3In assisted Dentilat&" 3/&!$li/ati&ns $neu!&th&"a,/&!$li/ati&ns $neu!&th&"a,

$neu!&!ediastinu! , $neu!&nia !a &//u"$neu!&!ediastinu! , $neu!&nia !a &//u"


101/115


102/115


103/115

=11R#L "PPR*-V1=11R#L "PPR*-V1M1#"R1"


104/115

M1#"R1"M1#"R1" Patients sh&uld (e t"eated in an ICUPatients sh&uld (e t"eated in an ICU

In ende!i/ a"eas t"eat!ent sh&uld (eIn ende!i/ a"eas t"eat!ent sh&uld (e/&!!en/ed as ea"l as $&ssi(le, s&!eti!es/&!!en/ed as ea"l as $&ssi(le, s&!eti!es

(e#&"e $&sitiDe $a"asit&l&(e#&"e $&sitiDe $a"asit&l&

Patients sh&uld (e Heihed s& that d&se Patients sh&uld (e Heihed s& that d&se

anti !ala"ial /an (e /al/ulatedanti !ala"ial /an (e /al/ulated I9 Quids sh&uld (e iDen t& !aintain QuidI9 Quids sh&uld (e iDen t& !aintain Quid

(alan/e and /al&"i/ "e'ui"e!ents% A /ent"al(alan/e and /al&"i/ "e'ui"e!ents% A /ent"al

line and !&nit&"in /ent"al Den&usline and !&nit&"in /ent"al Den&us

$"essu"e !a (e ne/essa", es$e/iall in$"essu"e !a (e ne/essa", es$e/iall in

elde"l% All intake sh&uld (e "e/&"ded /a"e#ullelde"l% All intake sh&uld (e "e/&"ded /a"e#ull

Ai"Ha, +en "e'ui"e!entAi"Ha, +en "e'ui"e!ent

T"eat h$e"$"eia T"eat h$e"$"eia

=11R#L "PPR*-V1=11R#L "PPR*-V1


105/115

M1#"R1"M1#"R1" U"ina" /athete"iati&n sh&uld (e used t& !&nit&"U"ina" /athete"iati&n sh&uld (e used t& !&nit&"

&ut$ut&ut$ut Patients sh&uld (e &(se"Ded #&" D&!itin% T&Patients sh&uld (e &(se"Ded #&" D&!itin% T&

ensu"e $atients sa#et, /&t-sides !a (e "e'ui"edensu"e $atients sa#et, /&t-sides !a (e "e'ui"ed

Reula" "e-$&siti&nin $atient is ne/essa" t&Reula" "e-$&siti&nin $atient is ne/essa" t&

$"eDent deDel&$!ent $"essu"e s&"es$"eDent deDel&$!ent $"essu"e s&"es Nas&ast"i/ tu(e sh&uld (e aD&ided (e/ause theNas&ast"i/ tu(e sh&uld (e aD&ided (e/ause the

"isk as$i"ati&n"isk as$i"ati&n M+NIT+RIN. .CS 8 9ITAL SI.NM+NIT+RIN. .CS 8 9ITAL SI.N

LA 3 6C, .LUC+SE, PAR%C+UNT, CREATININE, UREUM,LA 3 6C, .LUC+SE, PAR%C+UNT, CREATININE, UREUM,L++ .AS, URINE S%., S+IUM, P+TASSIUM%L++ .AS, URINE S%., S+IUM, P+TASSIUM%

PRE9ENT 3 S)+CK, SEPTICAEMIA, ACI+SIS, ARS,PRE9ENT 3 S)+CK, SEPTICAEMIA, ACI+SIS, ARS,

)7P+.L7CAEMIA, ASPIRATI+N, ES+RES%)7P+.L7CAEMIA, ASPIRATI+N, ES+RES%

T"eat!ent SeDe"e Mala"ia T"eat!ent SeDe"e Mala"ia


106/115

-2010-2010

SeDe"e Mala"ia is a !edi/al e!e"en/SeDe"e Mala"ia is a !edi/al e!e"en/

Adult 3 A"tesunate iD : i!Adult 3 A"tesunate iD : i!

Child"en 3 A"tesunate iD:i!, FuinineChild"en 3 A"tesunate iD:i!, Fuinine

iD:i!, A"te!ete" i!iD:i!, A"te!ete" i!

.iDe Pa"ente"al at least 24 h&u"s.iDe Pa"ente"al at least 24 h&u"s

SHi/th t& &"al 3 ACT, a"tesunate 5SHi/th t& &"al 3 ACT, a"tesunate 5

/linda!/in:d&//lin, 'uinine 5 Cl:d/linda!/in:d&//lin, 'uinine 5 Cl:d

I# n&t $&si((le, iDe $"e-"e#e"al R, thenI# n&t $&si((le, iDe $"e-"e#e"al R, then

"e#e""ed i!!ediatel"e#e""ed i!!ediatel

KE7 SUCCEE 6+R MANA.IN.KE7 SUCCEE 6+R MANA.IN.


107/115

SE9ERE MALARIASE9ERE MALARIA

A//u"a/ dian&sis !i/"&s/&$i/ (i&/he!i/al

Mala"ia d"u t& /&!(at "esisten/

A(ilit t& t"eat &"an #ailu"e ICU 8Medi/al e'ui$!ent

.&&d !an $&He" nu"ses --- d&/t&"

.&&d "e#e""al sste!

Ana!nesaAna!nesa


108/115

Ana!nesaAna!nesa

• KU 3 EMAMKU 3 EMAM• RPS3 EMAM SEJAK V ; )ARI SMRS%EMAMRPS3 EMAM SEJAK V ; )ARI SMRS%EMAM

TIN..I,ISERTAI EN.AN ERKERIN.AT AN7AK AN TIN..I,ISERTAI EN.AN ERKERIN.AT AN7AK AN

MEN.I.IL%PENERITA JU.A MEN.ELU) SAKIT KEPALAMEN.I.IL%PENERITA JU.A MEN.ELU) SAKIT KEPALA

SEJAK V ; )ARI SMRS, SEPERTI ITUSUK TUSUKSEJAK V ; )ARI SMRS, SEPERTI ITUSUK TUSUK

ISELURU) A.IAN KEPALA%MUAL AN MUNTA) - , AISELURU) A.IAN KEPALA%MUAL AN MUNTA) - , ASEPERTI IASA AN AK SEIKIT SEIKIT AN PENERITASEPERTI IASA AN AK SEIKIT SEIKIT AN PENERITA

ME.ELU) TIAK PUAS SAAT AK, N7ERI SAAT AK 5 %ME.ELU) TIAK PUAS SAAT AK, N7ERI SAAT AK 5 %

• RP3RP3

• )IPERTENSI, JANTUN.,.INJAL, AN PARU ISAN.KAL)IPERTENSI, JANTUN.,.INJAL, AN PARU ISAN.KAL

PENERITA%PENERITA%• PENERITA SEELUMN7A PERNA) ERPER.IAN IPENERITA SEELUMN7A PERNA) ERPER.IAN I

AERA) EPINEMIK MALARIA T+MATU AERA) EPINEMIK MALARIA T+MATU

Pe!e"iksaan 6isikPe!e"iksaan 6isik


109/115

Pe!e"iksaan 6isikPe!e"iksaan 6isik

• Ku 3 sedan, kesada"an 3 CMKu 3 sedan, kesada"an 3 CM• T 3 100:*0, N 3 100, R 3 20, S3 ; 5 0 /!)20• T)+RA 3 C 3 SI SII N+RMAL, ISIN. T)+RA 3 C 3 SI SII N+RMAL, ISIN.

P 3 S$%Desikule", Rh -:-, Gh-:-P 3 S$%Desikule", Rh -:-, Gh-:-

• A+MEN 3 ata", le!as, U 5 n&"!al,A+MEN 3 ata", le!as, U 5 n&"!al,

):L3tt(, NTE5, NK C9A 5 det"a):L3tt(, NTE5, NK C9A 5 det"a• Et"e!itas 3 )anat , +ede! -:-Et"e!itas 3 )anat , +ede! -:-

LA+RAT+RIUMLA+RAT+RIUM


110/115

LA+RAT+RIUMLA+RAT+RIUM

1*:@:20111*:@:2011•R 3 6ALCIPARUM 5%R 3 6ALCIPARUM 5%

200 l$3 10 $a"asit200 l$3 10 $a"asit

1000 l$3 -1000 l$3 -

L 3L 3•)(3 14,>)(3 14,>•Leuk&3 4*00Leuk&3 4*00•E"it"&sit3 4,@0 tE"it"&sit3 4,@0 t•)t3 4;?)t3 4;?•

LE3 10 !!LE3 10 !!

•Neut"&l (atan


111/115

Pen&(atanPen&(atan

1*:@:20111*:@:2011•C&a"te! 24 ta(C&a"te! 24 ta(

•P"i!a'uin 1; ta(P"i!a'uin 1; ta(

•Kina ;2 ta( a!Kina ;2 ta( a!2;%002;%00

1@:@:20111@:@:2011•P"i!akuin ta( 11P"i!akuin ta( 11

•Kina ;2 ta(Kina ;2 ta(

•A"tesunatA"tesunat•&ksisiklin 2200&ksisiklin 2200

!!

Pego5ata Malaria deJesiesi =$A$Pego5ata Malaria deJesiesi =$A$


112/115

gg

PDPD

6 Vivaks !heso strai 76 Vivaks !heso strai 7Min$$u &enis o6at &umla8 ta6let menurut kelompok umur/ min$$u

+ ( 16ulan

2 ( 11 6ulan

1 ( 4 ta8un

' ( : ta8un

1+ (14

ta8un

) 1'ta8un

1 s/d (12 Klorokuin ¼ ½ 1 2 3 3 - 4

1 s/d (12 Primakuin - - 1½ 2¼ 3

Pemantauan : Gagal rujuk

ACT

Pego5ata Malaria Vivax =#=#L #!* ? LiiPego5ata Malaria Vivax =#=#L #!* ? Lii


113/115

----

HariHari %eis o5at %eis o5at %umlah ta5let meurut kelompok umur %umlah ta5let meurut kelompok umur


K 8K 8tahutahu

8 $ )8 $ )tahutahu

22 – – 99tahutahu

8( $ 8)8( $ 8)tahutahu

:: 8282tahutahu

8$ B8$ B


114/115

%&'&()&' D(!* K6( (+&%+. 6K%&'&()&' D(!* K6( (+&%+. 6K

*+A+(++(+,(&' %&'&()&*+A+(++(+,(&' %&'&()&

)$&l/e!ia,)$&l/e!ia,

/hin/h&nis!,/hin/h&nis!,

tinnitus, hea"intinnitus, hea"ini!$ai"!ent,i!$ai"!ent,

nausea, ds$h&"ia,nausea, ds$h&"ia,

D&!itin, $"&l&nedD&!itin, $"&l&ned

FT inte"Dal,FT inte"Dal,

ds"hth!ias,ds"hth!ias,

h$&tensi&nh$&tensi&n

20 ! dihd"&/hl&"ide salt:k20 ! dihd"&/hl&"ide salt:k

( iD in#usi&n &De" 4 h", then( iD in#usi&n &De" 4 h", then

a#te" l&adin, #&ll&Hed ( 10a#te" l&adin, #&ll&Hed ( 10

!:k &De" 4 h" eDe" < h"%!:k &De" 4 h" eDe" < h"%Patients sh&uld n&t "e/eiDedPatients sh&uld n&t "e/eiDed

'uinine &" !eQ&'uine Hithin'uinine &" !eQ&'uine Hithin

last 24 h"last 24 h"

Alte"natiDel, * ! salt:kAlte"natiDel, * ! salt:k

/an (e in#used &De" a $e"i&d/an (e in#used &De" a $e"i&d

;0 !in, #&ll&Hed ( 10 ! ;0 !in, #&ll&Hed ( 10 !salt:k &De" a $e"i&d 4 h",salt:k &De" a $e"i&d 4 h",

&"&"

10 ! salt:k >00 ! #&"10 ! salt:k >00 ! #&"

adult ( i%D in#usi&n &De" < h"adult ( i%D in#usi&n &De" < h"

/&ntin&usl ; a da/&ntin&usl ; a da

uinineuinine

9=EI>9=EI> >?9?9


115/115

"

Tatalaksana Malaria 2010- Gabungan

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Transcript of Tatalaksana Malaria 2010- Gabungan