Treatment for severe malaria—based on national guidelines from the UK, Canada, USA and Australia, and WHO malaria treatment guidelines 201013 19 20–22
| Clinical diagnosis and species | Paediatric drug | Dose | Comments |
|---|---|---|---|
| Severe malaria Any (or mixed) Plasmodium species: | Treatment of choice: IV Artesunate | 2.4 mg/kg IV at 0, 12, and 24 hours, then once daily until oral therapy is tolerated (see below) | |
| P falciparum P vivax P ovale P malariae P knowlesi | Alternative treatment (if artesunate not available): IV Quinine dihydrochloride | Loading dose: 20 mg/kg IV over 4 h Maintenance dose: 10 mg/kg IV over 4 h, 8 hourly, starting 8 h after initiation of loading dose, until the patient is able to begin oral treatment (see below) | Requires slow infusion and cardiac monitoring (lethal hypotension possible if given rapidly) Quinine may exacerbate hypoglycemia |
| OR | |||
| Inability to tolerate oral therapy | When patient is able to tolerate oral therapy, give: (as in table 3 for uncomplicated P falciparum) | ||
| Artemether+lumefantrine (Riamet, Coartem)—full course of 6 doses OR Quinine+(clindamycin OR doxycycline)—full 7 day course | Loading dose of quinine is not required if patient has received – 3 or more doses of quinine or quinidine in the previous 48 h – mefloquine prophylaxis in the previous 24 h – mefloquine treatment dose within the previous 3 days | ||
| See also primaquine (table 4) to eradicate liver hypnozoites if species of Plasmodium is P vivax, P ovale, or unknown | |||