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aria
– Rapid diagnostic tests (RDT1s)
R apid tests d etect parasite antig ens. T h ey g iv e only a qualitativ e result (positiv e or
neg ativ e) and m ay rem ain positiv e sev eral d ays or w eeks follow ing effectiv e
treatm ent.
Note: ev en w ith positiv e d iag nostic results, rule out oth er causes of fev er.
Additional examinations
– H aem og lobin ( H b) lev el: to be m easured routinely in all patients w ith clinical
anaem ia, and in all patients w ith sev ere m alaria.
– B lood g lucose lev el: to be m easured routinely to d etect h ypog lycaem ia (< 3 m m ol/ l
or < 5 5 m g / d l) in patients w ith sev ere m alaria and th ose w ith m alnutrition.
Treatment of malaria due to P. vivax , P. mala2riae, P. ovale
chloroquine (CQ) P O
C h ild ren and ad ults: 1 0 m g base/ kg once d aily on D 1 , D 2
5 m g base/ kg on D 3
P. vivax and P. ovale can cause relapses d ue to activ ation of d orm ant parasites in th e
liv er. A treatm ent w ith prim aq3uine can be g iv en to elim inate th ese parasites, after th e
initial treatm ent w ith C Q . H ow ev er, th is treatm ent is reserv ed for patients liv ing in
areas w h ere re-infection is unlikely, i.e. non-end em ic or low transm ission areas.
Treatment of uncomplicated falciparum malaria
Antimalarial treatment (for preg nant w om en, see pag e 1 3 8 )
T h e treatm ent is an artem isinin-based com bination th erapy (A4 C T ) g iv en by th e oral
route for 3 d ays. T h e first-line A C T is ch osen accord ing to th erapeutic efficacy in th e
area und er consid eration. C oform ulations (2 antim alarials com bined in th e sam e tablet)
are preferred ov er coblisters (2 d istinct antim alarials presented in th e sam e blister). F or
d osing inform ation, see table next pag e.
If v om iting preclud es oral th erapy, treatm ent is started using I V or I M artesunate or I M
artem eth er (see pag e 1 3 5 ) or rectal artesunate (see pag e 1 3 4 ), d epend ing on av ailability,
until th e patient can tolerate a com plete 3 -d ay oral treatm ent w ith an A C T .
1 Most rapid tests detect the following antigens alone or in combination: HRP2 protein specific to P. falciparum;
an enzyme (Pf pLDH) specific to P. falciparum; an enzyme (pan pLDH) common to all 4 plasmodium species.
HRP2 may continue to be detectable for 2 to 3 weeks or more after parasite clearance; pLDH remains detectable
for several days (up to 2 weeks) after parasite clearance.
2 In general, P. vivax remains sensitive to CQ but resistance is found in Papua New Guinea, the Solomon Islands,
Burma, India, Indonesia and East Timor. In these regions, follow national recommendations.
3 Primaquine for 14 days: 0.25 to 0.5 mg/kg once daily in children > 4 years; 15 mg once daily in adults.
Primaquine is contra-indicated in individuals with G6PD deficiency. If G6PD deficiency cannot be tested
individually, the decision to prescribe primaquine must take into account the prevalence of deficiency in the
population.
4 ACT: a combination of artemisinin or one of its derivatives (e.g. artesunate, artemether) with another antimalarial
of a different class.
132
– Rapid diagnostic tests (RDT1s)
R apid tests d etect parasite antig ens. T h ey g iv e only a qualitativ e result (positiv e or
neg ativ e) and m ay rem ain positiv e sev eral d ays or w eeks follow ing effectiv e
treatm ent.
Note: ev en w ith positiv e d iag nostic results, rule out oth er causes of fev er.
Additional examinations
– H aem og lobin ( H b) lev el: to be m easured routinely in all patients w ith clinical
anaem ia, and in all patients w ith sev ere m alaria.
– B lood g lucose lev el: to be m easured routinely to d etect h ypog lycaem ia (< 3 m m ol/ l
or < 5 5 m g / d l) in patients w ith sev ere m alaria and th ose w ith m alnutrition.
Treatment of malaria due to P. vivax , P. mala2riae, P. ovale
chloroquine (CQ) P O
C h ild ren and ad ults: 1 0 m g base/ kg once d aily on D 1 , D 2
5 m g base/ kg on D 3
P. vivax and P. ovale can cause relapses d ue to activ ation of d orm ant parasites in th e
liv er. A treatm ent w ith prim aq3uine can be g iv en to elim inate th ese parasites, after th e
initial treatm ent w ith C Q . H ow ev er, th is treatm ent is reserv ed for patients liv ing in
areas w h ere re-infection is unlikely, i.e. non-end em ic or low transm ission areas.
Treatment of uncomplicated falciparum malaria
Antimalarial treatment (for preg nant w om en, see pag e 1 3 8 )
T h e treatm ent is an artem isinin-based com bination th erapy (A4 C T ) g iv en by th e oral
route for 3 d ays. T h e first-line A C T is ch osen accord ing to th erapeutic efficacy in th e
area und er consid eration. C oform ulations (2 antim alarials com bined in th e sam e tablet)
are preferred ov er coblisters (2 d istinct antim alarials presented in th e sam e blister). F or
d osing inform ation, see table next pag e.
If v om iting preclud es oral th erapy, treatm ent is started using I V or I M artesunate or I M
artem eth er (see pag e 1 3 5 ) or rectal artesunate (see pag e 1 3 4 ), d epend ing on av ailability,
until th e patient can tolerate a com plete 3 -d ay oral treatm ent w ith an A C T .
1 Most rapid tests detect the following antigens alone or in combination: HRP2 protein specific to P. falciparum;
an enzyme (Pf pLDH) specific to P. falciparum; an enzyme (pan pLDH) common to all 4 plasmodium species.
HRP2 may continue to be detectable for 2 to 3 weeks or more after parasite clearance; pLDH remains detectable
for several days (up to 2 weeks) after parasite clearance.
2 In general, P. vivax remains sensitive to CQ but resistance is found in Papua New Guinea, the Solomon Islands,
Burma, India, Indonesia and East Timor. In these regions, follow national recommendations.
3 Primaquine for 14 days: 0.25 to 0.5 mg/kg once daily in children > 4 years; 15 mg once daily in adults.
Primaquine is contra-indicated in individuals with G6PD deficiency. If G6PD deficiency cannot be tested
individually, the decision to prescribe primaquine must take into account the prevalence of deficiency in the
population.
4 ACT: a combination of artemisinin or one of its derivatives (e.g. artesunate, artemether) with another antimalarial
of a different class.
132
