Page 266 - ATP-P 11th Ed

MALARIA PROTOCOL

SPECIAL CONSIDERATIONS
1. Malaria MUST be considered in all febrile patients currently in, or recently in, a
malarious area.
2. It is not uncommon for malaria to present like pneumonia or gastroenteritis (with
vomiting and diarrhea).
SECTION 2 4. Consider bacterial meningitis in evaluating – treat for both disorders if meningi-
3. The use of chemoprophylaxis does not rule out malaria.
tis is suspected.

Signs and Symptoms
1. Prodrome of malaise, fatigue, and myalgia may precede febrile paroxysm by several
days.
2. Paroxysm characterized by abrupt onset of fever, chills, rigors, profuse sweats, head-
ache, backache, myalgia, abdominal pain, nausea, vomiting, and diarrhea (may be
watery and profuse) in P. falciparum.
3. Intermittent fever to >105° F (40° C) OR fever may be near continuous in P. falci-
parum malaria; classic “periodicity” is usually absent. Profuse sweating between febrile
paroxysms.
4. Tachycardia, orthostatic hypotension, tender hepatomegaly, and delirium (Cer ebral
malaria)
Management
1. Atovaquone 250mg/proguanil 100mg (Malarone ) 4 tabs qd for 3 days with food
®
PLUS primaquine 30mg daily for 14 days (MUST rule out G6PD deficiency before
giving primaquine)
2. Acetaminophen (Tylenol ) 1000mg PO q6hr prn for fever
®
Disposition
1. Urgent treatment and evacuation for complicated malaria (cerebral, pulmonary,
unstable vital signs). These indicate a medical emergency.
2. Routine evacuation for uncomplicated cases (normal vital signs, normal mental
status, tolerates PO, no cough/shortness of breath).

256 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 257