TABLE 17.4.
Treatment of Uncomplicated Malaria
| Notes | Cautions/Contraindicationsa | ||
|---|---|---|---|
| Plasmodium falciparum | |||
| First line treatment | Artemether lumefantrine (AL) | Take twice daily with fatty snack/drink to increase lumefantrine absorption. Four dosing bands. | Cautions: AL levels affected by CYP3A4 inducers and antiretroviral drugs. Patients with/on QTc prolongation drugs. |
| Dihydroartemisinin-piperaquine (DHAPP) | Once daily dosing. Manufacturer recommends take on an empty stomach because fatty food enhances PP absorption. Eight dosing bands. | PP dose dependent prolongation of the QTc interval. Contraindications: known congenital QTc prolongation in patient or family, on drugs or have a disease with long QTc | |
| Artesunate amodiaquine | Once daily dosing. Widely used in Africa. Four dosing bands. | Rarely causes transient neutropenia and transaminitis | |
| Artesunate mefloquine (ASMQ) | Once daily dosing. Most experience in SE Asia. Four dosing bands. Overall tolerability less than other ACTs. | Contraindicated in significant psychiatric disease (depression, anxiety neurosis), epilepsy. No repeat dose ≤2 months. | |
| Pyronaridine artesunate | Once daily dosing. Pediatric granules available. Four dosing bands for tablets (weight ≥20 kg) and three dosing for granules. | Contraindicated acute liver disease (jaundice and symptoms), severe liver disease (i.e., decompensated cirrhosis, Child-Pugh stage B or C). Severe renal impairment. | |
| Alternative treatment | Atovaquone proguanil (ATV-PG) | Once daily dosing. Take with food or milky drink to increase ATV absorption. Four dosing bands. Not recommended if parasitemia >2%. | Creatinine clearance <30 mL/min. No data in severe liver disease. ATV levels reduced by rifampicin, rifabutin, metoclopramide, tetracycline, efavirenz, and protease inhibitors. PG may enhance the anticoagulant effect of warfarin. |
| Mefloquine (MQ) | Total dose 25 mg/kg: 15 then 10 mg/kg over 2 days. | See ASMQ | |
| Quinine + doxycycline (QN + DOX) |
Give both for 7 days. Quinine may be given for 5 days. | QN: Cinchonism common. Bitter taste that children may not like. DOX contraindicated <12 years (United Kingdom), <8 years (United States). | |
| Plasmodium vivax | |||
| No chloroquine (CQ) resistance | CQ | Total dose 25 mg/kg in 48 hours: 10-10-5 or 10-5-5-5. Follow local recommendations. | Reduce dose with creatinine clearance <60 mL/min. Avoid in severe renal disease. |
| CQ resistance (CQR) | ACTs above or ATV-PG | CQR common in Indonesia, Papua New Guinea, SE Asia. Foci elsewhere. | |
| Plasmodium ovale; Plasmodium malariae | |||
| First line treatment | Chloroquine | As above | |
| Alternative treatment | ACTs above or ATV-PG | As above | |
| Plasmodium knowlesi | As above | ||
| First line treatment | ACTs as above | ASMQ, AL, and DHAPP effective. | As above |
| Alternative treatment | CQ, ATV-PG, MQ | CQ, ATV-PG, MQ effective in travelers. | As above |
ACT, Artemisinin-based combination.
a
The main cautions/contraindications are mentioned. Consult the latest manufacturers' package inserts for more details.