## First-Line Antimalarial for P. falciparum in India **Key Point:** Artemisinin-based combination therapy (ACT) is the WHO-recommended and NVBDCP-endorsed first-line treatment for uncomplicated *Plasmodium falciparum* malaria in India. **High-Yield:** The specific ACT recommended by NVBDCP is **artemether-lumefantrine** (or artesunate-amodiaquine as an alternative). This combination: - Rapidly reduces parasite burden (artemether component) - Prevents recrudescence (lumefantrine component) - Has low risk of resistance development - Achieves cure rates >95% in uncomplicated malaria ### Rationale for ACT Selection | Criterion | ACT (Artemether-Lumefantrine) | Chloroquine | Quinine | |-----------|-------------------------------|-------------|--------| | **Efficacy in CQ-resistant P. falciparum** | >95% | <50% | Variable | | **Speed of parasite clearance** | Rapid (24–48 hrs) | Slow | Moderate | | **Risk of resistance** | Low | High | Moderate | | **NVBDCP recommendation** | First-line | Not recommended | Second-line only | | **Dosing complexity** | Simple (fixed-dose combination) | Simple | Complex (IV/IM) | **Clinical Pearl:** Chloroquine resistance in *P. falciparum* is now widespread across India (>90% of isolates), making monotherapy ineffective. ACTs were introduced into NVBDCP guidelines post-2010 to combat this. **Mnemonic:** **ACT FAST** — Artemisinin Combination Therapy is the Fast, Accurate, Standardized Treatment for falciparum malaria. [cite:Park 26e Ch 10]
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