6 hrs after 1st dose 60 hrs after 1st dose 12 hrs after 1st dose 72 hrs after 1st dose 24 hrs after 1st dose Time to parasitaemia <1 % (in hours): 36 hrs 1st dose Parasite clearance time (thick film) (in hours): ☐ None ☐ Mechanical ventilation ☐ Haemodialysis Exchange transfusion Specific supportive therapy ☐ ☐ Erythrocyte apheresis used: ☐ Vasopressor therapy ☐ Antibiotic therapy ☐ Transfusion of RBC ☐ Transfusion of clotting factors Other: ☐ None ☐ Treatment failure (R I resistance) ☐ Bacterial superinfection/sepsis ☐ Circulatory collapse (Shock) ☐ failure Complications observed Respiratory ☐ Pulmonary oedema during antimalaria ☐ Acute renal failure treatment: ☐ Coma ☐ Convulsions ☐ Metabolic acidosis (pH <7,25) ☐ Spontaneous bleeding ☐ Hypoglycaemia (<40mg/dl) Outcome: ☐ Cure without sequellae ☐ Clinical improvement (Day ☐ Exitus …..) Outcome details: – Follow-up at day 7 Yes/No Follow-up: Follow-up at day 14 Yes/No after 1st dose Follow-up at day 28 Yes/No ☐ Direct or indirect signs of anaemia ☐ day 7 ☐day 14 ☐ day 28 or hemolysis Clinical/laboratory ☐ day 14 ☐ day 28 ☐ Abnormal liver function test abnormalities on follow-up examination ☐ day 14 ☐ day 28 ☐ Abnormal creatinine ☐ day 14 ☐ day 28 ☐ Neurologic abnormalities Adverse drug reaction suspected? Yes/No Screening for adverse drug reactions Adverse drug Day of Day of Severity at time point of Relation with drug cure reaction maximum intensity (Please, fill in: name of the drug + adverse drug reaction) Day Day ≠ ≠ Mild, no Moderate, Severe, No Possible Probable specific specific disabling or
6 hrs after 1st dose 60 hrs after 1st dose 12 hrs after 1st dose 72 hrs after 1st dose 24 hrs after 1st dose Time to parasitaemia <1 % (in hours): 36 hrs 1st dose Parasite clearance time (thick film) (in hours): Specific supportive therapy used: ☐ None ☐ Mechanical ventilation ☐ Haemodialysis ☐ Exchange transfusion ☐ Erythrocyte apheresis ☐ Vasopressor therapy ☐ Antibiotic therapy ☐ Transfusion of RBC ☐ Transfusion of clotting factors Complications observed during antimalaria treatment: ☐ None ☐ Treatment failure (R I resistance) ☐ Bacterial superinfection/sepsis ☐ Circulatory collapse (Shock) ☐ Respiratory failure ☐ Pulmonary oedema ☐ Acute renal failure ☐ Coma ☐ Convulsions ☐ Metabolic acidosis (pH <7,25) ☐ Spontaneous bleeding ☐ Hypoglycaemia (<40mg/dl) Other: Outcome: ☐ Cure without sequellae ☐ Clinical improvement ☐ Exitus (Day …..) Outcome – details: Follow-up: after 1st dose Follow-up at day 7 Follow-up at day 14 Follow-up at day 28 Yes/No Yes/No Yes/No Clinical/laboratory abnormalities on follow-up examination ☐ Direct or indirect signs of anaemia or hemolysis ☐ Abnormal liver function test ☐ Abnormal creatinine ☐ Neurologic abnormalities ☐ day 7 ☐day 14 ☐ day 28 ☐ day 14 ☐ day 28 ☐ day 14 ☐ day 28 ☐ day 14 ☐ day 28 Screening for adverse drug reactions Adverse drug reaction suspected? Yes/No Adverse drug reaction (Please, fill in: name of the drug + adverse drug reaction) Day of Day ≠ Day of cure Day ≠ Severity at time point of maximum intensity Relation with drug Mild, no specific Moderate, specific Severe, disabling or No Possible Probable