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Anti-malarials
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Malaria
Uncomplicated malaria Severe malaria
Falciparum malariaVivax malaria Falciparum malaria
Negligence CQ resistance
Quinine Inj.Artesunate Inj.
Arteether Inj.Followed byQuinine tab.Arte + Meflo
Arte + Sulfa & Pyri
Chloroquine(Oral)
Amodiaquine
Artesunate oral,
Artemether oral,Artemether + LumeArtesunate + MefloArte + Sulfa + Pyri
Sulfa + Pyri
Vivax malaria
CQ Inj.
Artesunate InjArteether InjCQ tab.
Artesunate tabSulfa + Pyri
Artesunate InjArteether Inj.
Followed byArte + MefloArte + Sulfa
& Pyri
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OpportunitiesArteplus CD/Falcigo/Plus
CQ in vivax
Malaria
Arte-CD
SP in CQresistantmalaria
Arte-CD
CQ in severevivax malaria
Falcigo/plus
SP in UC
Falci.Malaria
Arte/Fal plus
Aremetherin UC falci.
MalariaArte-CD
Falcigo
plus
Arteether inSevere
MalariaFalcigo
Falcigo
plus
Quinine insevere
malariaFalcigo
Falcigo plus
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Condition
Region is endemic for malaria.
Chloroquine resistant strains of P.vivaxand P.falciparum are seen in the region.
More cases of malaria were due tofalciparum.
Many cases were found to be havingmixed infection
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Situation 1-
CQ in vivax malaria
Patient concern:-
Patient is having high grade fever withmoderate chills.
Feeling of weakness
Loss of appetite
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Therapeutic needs
Faster fever clearance time
Faster parasite clearance time
To prevent the infection from becomingsevere.
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Focus point
To normalize the patient as early aspossible.
Effective treatment of mixed infection dueto vivax/falciparum.
Control the infection so that it does notbecomes severe.
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Call objective
To convert Chloroquine Rxer to Arteplus/CD in vivax/mixed malaria.
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Need identification
Dr. what are the major challenges you face whiletreating malaria ?
How difficult it is to find out the causative
pathogen of malaria when the patient mighthave already taken some treatment ?
In such cases for better treatment outcome, areyou looking for a drug which can treat both CQresistant vivax/mixed malaria effectively ?
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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.
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Feedback
Dr. looking at the benefits, do you thinkthat Arteplus CD is a better treatmentchoice where possibility of the mixed
infection can not be ruled out as comparedwith CQ ?
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Possible objection
CQ is more cost effective than AL?
Dr. I appreciate your concern for thepatients pocket but if you look at the costof lab test and the discomfort which thepatient has to undergo, you will find thatArteplus is more economical than CQ.
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Commitment
Dr. for better treatment outcome inmalaria, where there are chances of mixedinfection please recommend Arteplus/CD.
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Condition
Region is endemic for malaria.
Chloroquine resistant strains of P.vivaxand P.falciparum are seen in the region.
More cases of malaria were due tofalciparum.
Prevailing sulphur drug sensitivity in theregion
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Situation-2Sulfa + Pyri in CQ resistant vivax &
uncomplicated falciparum malaria.
Patient concern :-
Patientis having high grade fever withmoderate chills.
Rigors along with vomiting and malaise
Feeling of weakness ,loss of appetite
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Therapeutic needs
Instant relief from fever and rigors
Prevention of recrudescence.
To prevent the infection from becomingsevere
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Focus point
To provide relief from fever and othersymptoms of malaria.
To prevent recrudescence of the infectionin falciparum malaria.
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Call objective
To convert Sulfadoxine - PyrimethamineRxer to Arteplus/ CD in CQ resistant vivaxand uncomplicated falciparum malaria.
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Need identification
How frequently do you come across CQresistant malaria cases?
What is your drug of choice in suchcases?
Are you looking for a drug which can beused empirically for CQ resistant as wellas uncomplicated falciparum malaria?
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Benefit presentation
Dr. this article was published inParassitolgia 2004. In this article WHOhas recommended the use of AL in all the
countries experiencing resistance toconventional therapies like CQ orsulfadoxine/pyrimethamine.
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Benefit presentation
Dr. this article was published in Americanjournal of tropical hygiene,2007. Thisstudy was conducted on 99 Nepalese
patients with uncomplicated falciparummalaria.
Conclusion :- AL was found to be more
effective than SP for uncomplicatedFalciparum malaria.
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Feedback
What is your opinion regarding the use ofArteplus /CD in CQ resistant oruncomplicated falciparum malaria cases?
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Commitment
Dr. in coming 5 cases of CQ resistant anduncomplicated malaria cases, pleaserecommend Arteplus /CD.
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Condition
Drs using plain artemisinin compound in
the treatment of uncomplicated falciparummalaria.
Incidences of resistance against CQ andother antimalarials are on a rise.
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Situation 3
Artemether tab in uncomplicated
Falciparum malaria.
Patient concern:-
Patient is having high grade fever withmoderate chills.
Rigors along with vomiting and malaise
Feeling of weakness Loss of appetite
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Therapeutic needs
To reduce FCT & PCT
To prevent recrudescence of the infection
Prevention of the emergence of theresistance
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Focus point
To provide relief from fever and othersymptoms of malaria.
To prevent recrudescence of the infectionin falciparum malaria.
To prevent emergence of resistanceagainst other antimalarials.
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Call objective
To convert plain artemether Rxer toArteplus / CD or Falcigo plus inuncomplicated falciparum malaria.
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Need identification
What is your line of treatment in Uncomplicatedfalciparum malaria ?
How frequently do you see the infection
reappearance in such cases even after thetreatment with plain artemisinin compound?
In such cases are you looking for a drug whichwill not only help in preventing recrudescencebut will also reduce the likelihood of emergenceof resistance against other antimalarials?
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Benefit presentation
Dr. this study was published in Expertopinion on investigational drugs, 2000. Itsuggests that Artemisinin compounds like
Artemetheror Artesunateshould becombined with long acting antimalarialslike Lumefantrineor Mefloquine to prevent
recrudescence, to improve complianceand to prevent progression of resistanceagainst antimalarials.
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Feedback
How well do you think that Arteplus /CDorFalcigo pluscan help you in preventing therecrudescence, the emergence of
resistance and faster resolution ofsymptoms in uncomplicated falciparummalaria ?
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Commitment
Dr. In your forthcoming patients sufferingfrom uncomplicated falciparum malariadepend on Arteplus /CD for the prevention
of recrudescence, emergence ofresistance and faster resolution ofsymptoms.
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Condition
Endemic region for malaria
Resistant strains of vivax and falciparumare common in the region.
Several deaths were reported due tomalaria
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Situation-5Arteether /Artemether Inj.
In Severe malaria
Patient is having high grade fever with
chills. Severe headache and fatigue
Respiratory distress.
Jaundice Unconscious
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Therapeutic needs
Save the life of the patient.
To prevent other complications.
Faster clearance of the parasite from theblood.
To maintain high and sustainedconcentration of the drug in the blood toprevent recrudescence and to preventresistance development.
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Focus point
To save the life of the patient by havingprofound (fast and long) action of the drug.
To prevent further complications like organdamage.
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Call objective
To convert plain artemether /arteetherRxer to Falcigo Inj. in severe malaria.
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Need identification
What are the objectives of treatment insevere falciparum malaria ?
Which are the important parameters youare looking in for while Rxing a drug insuch cases ?
How important is the quick absorption and
safety of the drug in such situations?
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Benefit presentation
This article was published in New Englandjournal of medicine, 2008. This articleclearly states that the efficacy of the fat
soluble artemisinin compounds i.e.arteether & artemether in severe malaria islimited due to its varied absorption (they
are given IM). Artesunate is having morereliable pharmacokinetic profile as it iswater soluble(given IV).
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Benefit presentation
Dr. the same study speaks about thesafety profile of AS as fat solubleartemisinins were found to be more
neurotoxic as compared to AS.
AS dosage need not be changed inhepatic and renal failure cases.
No drug interaction is seen so far with AS.
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Feedback
How well do you think that Falcigo canhelp you in saving the life and preventingfurther complications in severe falciparum
malaria ?
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Commitment
Dr. In your forthcoming patients sufferingfrom severe malaria, depend on Falcigoinj. & tab for saving the life and preventing
further complications.
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Condition
Endemic region for malaria.
Many deaths has happened due to malaria
Mostly P.falciparum was seen to beresponsible for causing malaria.
MDR strains of falciparum are common inthe region.
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Situation-6Quinine Inj. In Severe malaria
High grade fever.
Severe headache and fatigue Respiratory distress/ Dyspnea.
Jaundice
Unconscious
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Focus point
To save the life of the patient
To prevent further complications like organdamage.
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Call objective
To convert plain Quinine Rxer to FalcigoInj. in severe malaria.
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Need identification
What are the objectives of treatment insevere falciparum malaria ?
Which are the important parameters youare looking in for while Rxing a drug insuch cases ?
How important is the risk reduction of
death and safety of the drug in suchsituations?
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Benefit presentation
This article was published in New Englandjournal of medicine, 2008. This articleclearly states that risk reduction of death
was 34.7% more with AS as comparedwith Quinine.
Artesunate was found to be having leastside effects unlike Quinine havinghypoglycemia, visual disturbances andtinnitus as common one.
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Feedback
How well do you think that Falcigo canhelp you in saving the life and preventingfurther complications in severe falciparum
malaria ?
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Commitment
Dr. In your forthcoming patients sufferingfrom severe malaria, depend on Falcigoinj. & tab for saving the life and preventing
further complications.