## Antimalarial Policy in India **Key Point:** Artemisinin-based combination therapy (ACT) is the WHO-recommended and NVBDCP-endorsed first-line treatment for uncomplicated P. falciparum malaria in India. ### Current NVBDCP Guidelines The National Vector Borne Disease Control Programme adopted ACT as the standard first-line regimen due to: - High efficacy (>95% cure rate) - Rapid parasite clearance (reduces gametocyte transmission) - Lower risk of resistance development - Artemether-lumefantrine is the most widely deployed ACT in India **High-Yield:** Artemether-lumefantrine is a fixed-dose combination (FDC) of an artemisinin derivative (fast-acting) + lumefantrine (long-acting), providing both rapid symptom relief and sustained cure. ### Chloroquine Status Chloroquine resistance in P. falciparum became widespread in India by the 1990s–2000s, leading to its discontinuation as monotherapy for falciparum malaria. It is retained only for P. vivax and P. ovale in certain endemic zones where susceptibility persists. **Clinical Pearl:** Primaquine is NOT a first-line monotherapy; it is used as an adjunct to eliminate hypnozoites in P. vivax and P. ovale infections (given after the acute attack is controlled). | Drug | Indication | Status | |------|-----------|--------| | Artemether-lumefantrine | P. falciparum (uncomplicated) | First-line (NVBDCP) | | Chloroquine | P. vivax, P. ovale | Retained where susceptible | | Primaquine | P. vivax, P. ovale (hypnozoite clearance) | Adjunct, not monotherapy | | Quinine | Severe malaria / pregnancy | Second-line | [cite:Park 26e Ch 8]
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