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¡¡¡ãÁøÂû¼Ò°ß= ¡â°£, ºñÀåÁ¾´ë: ¹ß¿±â°£ÀÌ ±æ¾îÁö¸é °£, ºñÀåÁ¾´ë°¡ »ý±â°í µå¹°°Ô ºñÀå ÆÄ¿ µîÀÇ ÇÕº´ÁõÀÌ »ý±æ ¼ö ÀÖ´Ù. ¡â´ÙÀå±â ºÎÀü: P. falciparum¿¡ ÀÇÇÑ ¿´ë¿ ¸»¶ó¸®¾Æ´Â ÀûÀýÇÑ ¾àÁ¦Ä¡·á°¡ ¹Ù·Î ½ÃÀÛµÇÁö ¾ÊÀ¸¸é ³ªÁß¿¡´Â ´Ù±â°ü ±â´ÉºÎÀü(multiorgan failure)À» À¯¹ßÇÏ¸ç »ç¸Á¿¡ À̸£±âµµ ÇÑ´Ù.
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¡¡¡ãÇ÷¾×µµ¸»°Ë»ç= ±Þ¼º±â¿¡ ¸»¶ó¸®¾Æ¸¦ Áø´ÜÇÏ´Â À¯ÀÏÇÑ ¹æ¹ýÀº Ç÷¾×µµ¸»°Ë»ç·Î ¿øÃæÀ» È®ÀÎÇÏ´Â °ÍÀÌ´Ù. ¡âÈÄÃþµµ¸»(thick smear): ¿øÃæ ÀÚü¸¦ °Ë»öÇÏ´Â ¿¹¹Îµµ°¡ ¹ÚÃþ¸ð¸»¿¡ ºñÇÏ¿© ³ôÁö¸¸ ÆÇµ¶ÀÌ ¾î·Æ´Ù. ¡â¹ÚÃþµµ¸»(thin smear): ÀûÇ÷±¸³»ÀÇ ¿øÃæÀ» È®ÀÎÇϰí Á¾(species)ÀÇ °¨º°¿¡ µµ¿òÀÌ µÈ´Ù.
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¡¡¡ãÄ¡·á ½ÇÁ¦= ¡âP. vivax, P. ovale, P. malariae¿¡ ÀÇÇÑ ¸»¶ó¸®¾Æ: ´ë°³ ÇÕº´ÁõÀÌ ¾ø°í Ä¡·á°¡ ¿ëÀÌÇÑ °ÍÀÌ Æ¯Â¡ÀÌ´Ù. ÆÄǪ¾Æ ´º±â´Ï¾Æ¿Í ÀÌ¿¡ ÀÎÁ¢ÇÑ Àεµ³×½Ã¾Æ Áö¿ªÀ» Á¦¿ÜÇϰí´Â P. vivax, P. ovale, P. malariae¿¡ ÀÇÇÑ ¸»¶ó¸®¾Æ´Â ±âº»ÀûÀ¸·Î chloroquine °¨¼ö¼ºÀ¸·Î °£ÁÖÇÑ´Ù. µû¶ó¼ chloroquine Åõ¿©°¡ ±Ù°£ÀÌ µÇ¸ç ó¹æ ¹æ¹ýÀº <Ç¥ 1>°ú °°´Ù. ¡âP. falciparum¿¡ ÀÇÇÑ ¸»¶ó¸®¾Æ: ºÏºÎ ¾ÆÇÁ¸®Ä«, ÆÄ³ª¸¶ ¿îÇÏ ºÏºÎÀÇ Áß¹ÌÁö¿ª, ÇÏÀÌÆ¼, Áßµ¿Áö¿ª¿¡¼ cloroquine °¨¼ö¼ºÀÎ °ÍÀ» Á¦¿ÜÇϰí´Â, ±×¿ÜÀÇ ¿´ë¿ ¸»¶ó¸®¾Æ ¹ß»ý Áö¿ªÀÎ »çÇ϶ó »ç¸· À̳²ÀÇ ¾ÆÇÁ¸®Ä«, µ¿³²¾Æ½Ã¾Æ ´ëºÎºÐ, Àεµ¸¦ Æ÷ÇÔÇÑ ¼³²¾Æ½Ã¾Æ, ¿´ë ³²¹Ì Áö¿ª¿¡¼ ¸ðµÎ chloroquine ³»¼ºÀÌ´Ù.
¡¡µû¶ó¼ chloroquineÀ» Á¦¿ÜÇÑ ±âŸ ¾àÁ¦¸¦ ½Ã¿ëÇϸç Ä¡·á ¾àÁ¦ ¹× ¹æ¹ýÀº <Ç¥ 2>¿Í °°´Ù. ÁßÁõ ¸»¶ó¸®¾ÆÀÇ °æ¿ì´Â ÁÖ»çÁ¦·Î, °æÁõ ¸»¶ó¸®¾Æ´Â °æ±¸ Ç׸»¶ó¸®¾Æ Á¦Á¦·Î Ä¡·áÇÑ´Ù.
¡¡¡ãÇÕº´Áõ Ä¡·á= ÁßÁõ ¸»¶ó¸®¾Æ¿¡¼´Â ÇÕº´Áõ¿¡ ´ëÇÑ Ä¡·áµµ Ç׸»¶ó¸®¾Æ ¾àÁ¦ Åõ¿© ¸øÁö¾Ê°Ô Áß¿äÇÏ´Ù. ¡â¼ö¾× º¸Ãæ ¡âÅõ¼®(¼Òº¯·®ÀÌ ÁÙ°í ´ë»ç¼º »êÁõ, °íÄ®·ýÇ÷Áõ ¶Ç´Â ÆóºÎÁ¾ÀÌ »ý±â¸é, Ç÷¾×Åõ¼®À̳ª º¹¸·Åõ¼®À» ½ÃÀÛÇØ¾ß ÇÑ´Ù) ¡âÀúÇ÷´ç ¿¹¹æ(ÀÀ±Þ Ä¡·á·Î 50% glucose¸¦ °ø±ÞÇÑ´Ù) ¡â°æ·Ã Ä¡·á ¡â±³È¯ ¼öÇ÷(±â»ýÃæ Ç÷ÁõÀÌ 10%¸¦ ³Ñ´Â °æ¿ì¿¡´Â ½ÃÇàÇÏ´Â °ÍÀÌ ÁÁ´Ù).
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¡¡¡ã¿¹¹æÀû ÈÇпä¹ýÀÇ ½ÇÁ¦= ¿¹¹æÀû ÈÇпä¹ýÀÇ ±âº»ÀÌ µÇ´Â chloroquineÀ̳ª melfloquineÀ» ºñ·ÔÇÏ¿©, ¿¹¹æÀû ÈÇпä¹ý¿¡ »ç¿ëµÇ´Â ¾àÁ¦¿Í ¿ë·®Àº <Ç¥ 3>°ú °°´Ù. P. vivax À¯Çà Áö¿ª¿¡¼ ¸ð±â¿¡ ¸¹ÀÌ ¹°¸±¼ö·Ï, °£³» Àẹ °¨¿°ÀÇ À§Çè·üµµ Áõ°¡ÇÑ´Ù.
¡¡P. vivax¿Í P. ovale¿¡ ÀÇÇÑ °£³» hypnozoite¸¦ ±ÙÀýÇϱâ À§ÇØ »ç¿ëÇÏ´Â primaquine¿¡ ´ëÇÑ ³»¼ºÀÌ ¼Ö·Î¸ó ±ºµµ, Àεµ³×½Ã¾Æ, ű¹, ÆÄǪ¾Æ´º±â´Ï¾Æ, ¿¡Äí¾Æµµ¸£ µî¿¡¼ º¸°íµÇ°í ÀÖÀ¸¹Ç·Î, ÀÌ Áö¿ª¿¡¼ ¹ß»ýÇÑ »ïÀÏ¿ ¸»¶ó¸®¾Æ Ä¡·á½Ã primaquineÀÇ ¿ë·®À» 2¹è·Î Áõ·®ÇÏ´Â °Íµµ °í·ÁÇØ º¸¾Æ¾ß ÇÑ´Ù.
<Ç¥ 1> P. vivax, P. ovale, P. malariae¿¡ ÀÇÇÑ ¸»¶ó¸®¾ÆÀÇ Ä¡·á
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ADULTS |
CHILDREN |
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P. vivax and P.ovale |
Chloroquine at a total 1500mg (base) given as follows: Day 1 L600mg (base) first dose, followed by 300mg (base) at 6 hours later. Day 2:300mg (base). Day 3:300mg (base) Day 4 to 17: PQ 15mg daily. |
chloroquine total 25mg (base)/kg given as follows: Day 1:10mg(base)/kg first dose, followed by 5mg(base)/kg at 6 hours later. Day 2:5mg (base)/kg Day 3:5mg (base)/kg Day 4 to 17: PQ(age over one year) at 0.25mg/kg daily. |
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P. malariae |
chloroquine at a total 1500mg (base) given as follows: Day 1:600mg(base) first dose, followed by 300mg(base) at 6 hours later. Day 2:300mg (base). Day 3:300mg(base). |
chloroquine 25mg (base)/kg as a total dose, given as follows : Day 1:10mg(base)/kg first dose, followed by 5mg (base)/kgat 6 hours later. Day 2:5mg (base)/kg Day 3:5mg (base)/kg |
<Ç¥ 2> P. falciparum ¸»¶ó¸®¾ÆÀÇ Ä¡·á
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Drug |
Uncomplicated Malaria (Oral) |
Severe Malaria (Parenteral) |
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Chloroquine |
10 mg of base/kg followed by 10 mg/kg at 24 h and 5 mg/kg at 48 h or by 5 mg/kg at 12, 24, and 36 h (total dose, 25 mg/kg); for P. vivax or P. ovale, primaquine (0.25 mg of base/kg per day for 14 days) added for radical cure |
10 mg of base/kg by constant-rate infusion over 8 h followed by 15 mg/kg over 24 h or by 3.5 mg of base/kg by IM or SC injection every 6 h (total dose, 25 mg/kg) |
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Mefloquine |
15 mg/kg followed 8-12 h later by second dose of 10 mg/kg |
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Quinine |
10 mg of salt/kg q8h for 7 days combined with tetracycline (4 mg/kg qid) or doxycycline (3 mg/kg once daily) or clindamycin (10 mg/kg bid) for 7 days |
20 mg of salt/kg by IV infusion over 4 h followed by 10 mg/kg infused over 2-8 h every 8 h |
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Quinidine gluconate |
- |
10 mg of base/kg by constant-rate infusion over 1-2 h followed by 0.02 mg/kg per min, with ECG monitoring |
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Artesunate |
In combination with 25 mg of mefloquine/kg, 12 mg/kg given in divided doses over 3-5 days (e.g., 4 mg/kg for 3 days or 4 mg/kg followed by 2 mg/kg per day for 4 days); if used alone or in combination with clindamycin or doxycycline, give for 7 days (usually 4 mg/kg initially followed by 2 mg/kg daily) |
2.4 mg/kg IV or IM stat followed by 1.2mg/kg at 12 and 24 h and then daily(or 2.4 mg/kg once daily) |
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Artemether |
Same regimen as for artesunate |
3.2 mg/kg IM stat followed by 1.6 mg/kg per day |
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Atovaquone- proguanil (Malarone) |
For adults >40 kg, each dose comprises 4 tablets (each tablet containing atovaquone 250 mg and proguanil 100 mg) taken once daily for 3 days with food |
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Artemether- lumefantrine |
For adults ¡Ã35 kg, each dose comprises 4 tablets (each tablet containing artemether 20 mg and lumefantrine 120 mg) at 0, 8, 24, 36, 48, and 60 h, taken after food |
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<Ç¥ 3> ¸»¶ó¸®¾ÆÀÇ ÈÇÐÀû ¿¹¹æ
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Áö¡¡¡¡¿ª |
¿¹ ¹æ ¾à |
Åõ¿©¹æ¹ý |
±â¡¡¡¡°£ |
|
CS area* |
Chloroquine |
300mg base/wk |
1-2ÁÖÀü¡4ÁÖÈÄ |
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CR area¢Ó |
Mefloquine Doxycycline Atovaquone- proguanilPrimaquine |
250mg salt/wk 100mg/d 250/100mg/d3 0mg/d |
1-2ÁÖÀü¡4ÁÖÈÄ 1-2ÀÏÀü¡4ÁÖÈÄ 1-2ÀÏÀü¡1ÁÖÈÄ 1-2ÀÏÀü¡1ÁÖÈÄ |
|
MR area¢Ô |
Doxycycline Atovaquone- proguanil |
250mg salt/wk 100mg/d, 250/100mg/d |
1-2ÁÖÀü¡4ÁÖÈÄ 1-2ÀÏÀü¡1ÁÖÈÄ |
*chloroquine-sensitive ¢Óchloroquine-resistant ¢Ômefloquine-resistant