Treatment for uncomplicated malaria—based on national guidelines from the UK, Canada, USA and Australia, and WHO malaria treatment guidelines 201013 19–22
| Clinical diagnosis and species | Paediatric drug | Dose | Comments |
|---|---|---|---|
| Uncomplicated malaria P falciparum or unidentified species | Treatment of choice: Artemether+lumefantrine (Riamet, Coartem) Alternative treatments: Atovaquone+proguanil (Malarone) Quinine+(clindamycin OR doxycycline*) |
1 tablet=20 mg artemether/120 mg lumefantrine 5–14 kg: 1 tablet 15–24 kg: 2 tablets 25–34 kg: 3 tablets >34 kg: 4 tablets (adult dose) Orally, at 0, 8, 24, 36, 48, and 60 h Adult tab: 250 mg atovaquone/100 mg proguanil Paediatric tab: 62.5 mg atovaquone/25 mg proguanil 5–8 kg: 2 paediatric tablets 9–10 kg: 3 paediatric tablets 11–20 kg: 1 adult tablet 21–30 kg: 2 adult tablets 31–40 kg: 3 adult tablets >40 kg: 4 adult tablets (adult dose) Orally, once daily×3 days Quinine sulphate† 1 tablet=300 mg salt 10 mg salt/kg (up to 600 mg) orally 8 hourly×7 days PLUS EITHER Clindamycin 5 mg/kg (up to 300 mg) orally 8 hourly×7 days OR Doxycycline (note age limitations*) 2.5 mg/kg (up to 100 mg) orally 12 hourly×7 days | Should not be used if Malarone has been taken as prophylaxis Can be used even if mefloquine has been taken as prophylaxis |
| See also primaquine (table 4) to eradicate liver hypnozoites if species of Plasmodium is unknown | |||
| Uncomplicated malaria P vivax, P ovale, P malariae, or P knowlesi All regions except if suspected chloroquine-resistant P vivax (see below) | Chloroquine phosphate‡ or hydroxychloroquine sulphate§ OR Artemether+lumefantrine (Riamet, Coartem) | Chloroquine 1 tablet=155 mg base=250 mg salt Hydroxychloroquine 1 tablet=155 mg base=200 mg salt 10 mg base/kg (up to 620 mg) orally at 0 h, then 5 mg base/kg up (to 310 mg) at 6, 24, and 48 h Total dose 25 mg base/kg As above for uncomplicated P falciparum | **Chloroquine-resistant P vivax, previously confined to Indonesia, Timor-Leste, and the Pacific Island Nations, is now increasingly reported throughout Southeast Asia, parts of Africa, and South America. Chloroquine-resistance has not been substantially reported in other non-falciparum species. Seek expert advice regarding current local epidemiology and treatment Choice of drug dependent on local availability |
| See also primaquine (table 4) to eradicate liver hypnozoites if species of Plasmodium is P vivax, P ovale, or unknown | |||
| Uncomplicated malaria P vivax Known chloroquine-resistant P vivax regions (increasingly widespread, see Comments in row above) | Treatment of choice: Artemether+lumefantrine (Riamet, Coartem) Alternative treatments: Atovaquone+proguanil (Malarone) Quinine+(clindamycin OR doxycycline*) Mefloquine | As above for uncomplicated P falciparum As above for uncomplicated P falciparum As above for uncomplicated P falciparum 15 mg/kg (up to 750 mg) orally at 0 h, then 10 mg/kg (up to 500 mg) 6–12 h later | Should not be used if Malarone has been taken as prophylaxis Should not be used if mefloquine has been taken as prophylaxis or illness acquired in Southeast Asia. Also, treatment doses of mefloquine are often poorly tolerated |
| See also primaquine (table 4) to eradicate liver hypnozoites | |||
*Doxycycline is permissible in children >8 years of age in the US, Canadian and Australian guidelines,19–21 and in children >12 years of age in the UK guidelines22
†Quinine sulphate 10 mg/kg salt=8.3 mg/kg base.
‡Chloroquine phosphate 10 mg/kg base=16.1 mg/kg salt.
§Hydroxychloroquine sulphate 10 mg/kg base=12.9 mg/kg salt.