Table 3.
| Uncomplicated P. falciparum malaria | |
|---|---|
| Artemether-lumefantrine (Riamet) | Recommended first-line ACT Four tablets at 0, 8, 24, 34, 48 and 60 h (>35 kg) Take with milk or fatty food |
| Dihydroartemisinin-piperaquine | Second-line ACT Three tablets daily for 3 days (36–60 kg) or four tablets daily for 3 days (>60 kg) |
| Atovaquone-proguanil (Malarone) | Four tablets daily for 3 days Not to be used if patient took Malarone prophylaxis Take with milk or fatty food |
| Quinine PLUS doxycycline or clindamycin | Quinine 600 mg 8 hourly for 5–7 days PLUS doxycycline 200 mg daily or clindamycin 450 mg 8 hourly for 7 days |
| Severe or complicated malaria | |
| IV Artesunate | First-line treatment 2.4 mg/kg at 0, 12 and 24 h, then once daily If not available, do not delay treatment, give IV quinine as alternative Can cause QTc prolongation – check ECG |
| IV Quinine | Alternative if IV artesunate not available 20 mg/kg loading dose over 4 h, followed by 10 mg/kg three times a day |
| Complete full course of oral treatment when patient can tolerate oral therapy | |
| Non-falciparum malaria | |
| Artemether-lumefantrine (Riamet) | Recommended first-line ACT Four tablets at 0, 8, 24, 34, 48 and 60 h (>35 kg) Take with milk or fatty food |
| Chloroquine | 620 mg initially, 310 mg at 6, 24 and 48 h (NB Avoid if infection acquired in areas with known chloroquine resistance) |
| Severe/complicated malaria – treat as per severe/complicated P. falciparum malaria | |
| Prevention of relapse (P. vivax / P. ovale spp.) | |
| Primaquine | 30 mg daily for 14 days (P. vivax) or 15 mg daily for 14 days (P. ovale spp.) Check for G6PD deficiency prior to treatment Reduced dosing may be used in mild-moderate G6PD deficiency – consult a specialist |
| Pregnancy | |
| Artemether-lumefantrine (Riamet) | First-line treatment in second/third trimester Seek specialist advice regarding use in first trimester |
| Quinine plus clindamycin | Safe in all trimesters |
| Severe malaria | IV artesunate IV quinine can be given as an alternative until IV artesunate available |
| Relapse prevention | Do not give primaquine during pregnancy Treat with chloroquine 310 mg weekly until pregnancy complete Do not use primaquine while breast feeding until infant G6PD status is known |