Paper II
Question
(
- (a) Outline the management of Falciparum Malaria. ( 3 mark(s)
- (b) Write one Artemisinin based combination therapy egimen”. ( 2 mark(s)
- (c) Metronidazole. 3 mark(s)
Answer
a) Management of falciparum malaria
- Uncomplicated: full oral course of an Artemisinin-based Combination Therapy (ACT).
- Severe/complicated (defined by cerebral malaria, severe anemia, acute kidney injury, pulmonary edema/ARDS, hypoglycemia, acidosis, or high parasitemia): IV artesunate is current first-line, having replaced IV quinine after trial evidence of a significant mortality reduction. IV quinine remains a second-line/alternative option, given by controlled infusion (never rapid push, given cardiotoxicity risk). Supportive care — careful fluid management (avoiding pulmonary edema from over-aggressive resuscitation), glucose monitoring/correction, and management of complications as they arise — is a major component of survival. Once the patient tolerates oral therapy, treatment is completed with a full oral ACT course.
b) One ACT regimen Artemether + Lumefantrine — the artemisinin component (artemether) rapidly reduces parasite biomass, while the longer-acting partner drug (lumefantrine) clears the remaining parasites, reducing the risk of resistance emerging to either component alone.
c) Metronidazole A nitroimidazole antimicrobial. MOA: reduced by anaerobic organisms’ ferredoxin-mediated electron transport, generating cytotoxic free-radical intermediates that cause DNA strand breakage. Uses: anaerobic bacterial infections, amoebiasis, giardiasis, trichomoniasis, H. pylori eradication. Adverse effects: metallic taste, peripheral neuropathy with prolonged use, disulfiram-like reaction with alcohol.