MALARIA

For the first 3 days—Quinine grs. 10 t.d.s. In bed.

For the next 5 days—Atebrin gm. 0.1, t.d.s. In bed.

Interval—no treatment—3 days—begin to get up. Then for 5 days Plasmoquine gm. 0.01 twice daily, or t.i.d. for 3 days.

Plasmoquine must always be given after meals.

An alkali mixture should be given during and for some days after the Q.A.P. course.

During the Plasmoquine course and for some days after, a lot of carbohydrate should be taken, preferably as sugar or sweet fruit drinks. If toxic symptoms occur, e.g., cyanosis, epigastric pain, stop the plasmoquine at once.

Quinine may be given as the sulphate, bisulphate or bihydrochloride, and when possible should always be given in a mixture, e.g., ‘Quin Sulph grs. 10 Ac Sulph Dil M 10 Aq Chloroformi ad 1 oz.’

Atebrin and Plasmoquine are in tablet form:

Tab Atebrin contains 0.1 gramme Care must be taken to see that the correct dose is given.

Tab Plasmoquine contains 0.01 gramme the correct dose is given.

Quinine may have to be given intramuscularly, e.g., in severe M.T. infections or where oral quinine is not absorbed, as in cases with vomiting.

The bihydrochloride is used, grs. 10 in 4 c.c. sterile water. In grave emergencies, e.g., cerebral malaria, the quinine has to be given intravenously. Use Quin Bihydrochloride grs. 10 in 20 c.c. sterile saline sol.

RELAPSING MALARIA

Second or subsequent relapses indicate that the routine Q.A.P. course has not been effective, and the following course should be adopted:

1.	Begin with the usual Q.A.P. course but combine with the plasmoquine course, Quinine grs. 10 t.i.d. page 527
2.	Give adrenalin 0.5 c.c. once daily during the last 3 days of plasmoquine course.
3.	Finish with 3 doses of N.A.B. 0.45 gm., one every 5th day, beginning 3 days after last dose of plasmoquine. During these 3 days and till course of NAB is completed continue alkaline mixture and copious sweet drinks and fruit juice.