Treatment Plan: Uncomplicated P. falciparum Malaria (38 kg child) — per IAP Standard Treatment Guidelines

First-line options (IAP Standard Treatment Guidelines, Ch. 95 – Malaria)

Option 1 – Artemether-Lumefantrine (AL) — preferred, especially in NE India

• Give with fatty food, whole milk, or a milk-based snack — fat markedly boosts lumefantrine absorption and treatment failure risk rises if taken empty-stomach.
• If the child vomits within 30-45 minutes of a dose, repeat that dose (give an antiemetic like ondansetron/domperidone first if vomiting is a problem).

Option 2 – Artesunate + Sulfadoxine-Pyrimethamine (ASP)

• Artesunate: 4 mg/kg/day once daily x 3 days → 4 x 38 = 152 mg/day (round to nearest available tablet strength, typically ~150 mg using 50 mg tablets) — Day 1 (24 Aug), Day 2 (25 Aug), Day 3 (26 Aug).
• Sulfadoxine-Pyrimethamine: single dose on Day 1 only — Sulfadoxine 25 mg/kg (25 x 38 = 950 mg) + Pyrimethamine 1.25 mg/kg (1.25 x 38 = 47.5 mg). With standard 500 mg/25 mg tablets this is 2 tablets as a single dose today.

Supportive care

• Antipyretics (paracetamol 10-15 mg/kg/dose) for fever; avoid NSAIDs.
• Maintain oral hydration; monitor for dehydration.
• Ensure the malaria species is confirmed as P. falciparum alone — if it turns out to be a mixed P. vivax + falciparum infection, IAP adds primaquine 0.25 mg/kg once daily for 14 days after G6PD screening (avoid or use the deficient-patient regimen of 0.6-0.8 mg/kg once weekly x 6 weeks if G6PD deficient).

Monitoring / when to escalate

• Persistent vomiting/inability to retain oral drugs
• Altered consciousness, seizures, unusual drowsiness
• Dark/tea-colored urine, jaundice, bleeding
• Breathing difficulty, cold extremities, poor perfusion
• Fever not improving by 48-72 hours after starting treatment (consider treatment failure/resistance, repeat blood smear)

Follow-up

• Repeat peripheral smear/RDT if fever persists beyond 72 hours of adequate therapy.
• Day 7 and Day 28 follow-up smears are reasonable to confirm parasite clearance and rule out recrudescence, per general ACT follow-up practice.
• Advise on mosquito-bite prevention (nets, repellents) to prevent reinfection.

• Give with a light snack/food to reduce nausea; artesunate does not need fat for absorption (unlike artemether-lumefantrine).
• Keep dosing at roughly the same time each evening (±1-2 hours is fine) for consistency and easier monitoring overnight.
• If the child vomits within 30-45 minutes of a dose, give an antiemetic (ondansetron or domperidone) and repeat that dose.
• SP is a single dose given only on Day 1, not repeated on Days 2-3.
• Recheck temperature and general condition each day; if fever hasn't started settling by the evening of Day 2 (~48 hrs), or if any danger signs appear (drowsiness, vomiting everything, dark urine, breathing difficulty), seek urgent medical review rather than continuing at home.
• Since the child is in Mumbai (Western India, not Northeast), the artesunate + SP regimen is appropriate per IAP guidance; SP resistance concerns apply mainly to the Northeastern states.