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aria
Notes:
I n infants below th e ag e/ w eig h t m entioned in th e table abov e, th ere is little d ata on
efficacy and safety of A C T s.
T h e com binations A L , A S- A Q and D H A - P P Q can be used . T h e d ose sh ould be
calculated so as to correspond to 1 0 -1 6 m g / kg / d ose of lum efantrine; 1 0 m g / kg / d ay of
am od iaquine; 1 6 -2 6 m g / kg / d ay of piperaquine).
T h e com bination A S-SP sh ould not be used d uring th e first w eeks of life.
C linical cond ition of young ch ild ren can d eteriorate rapid ly; it m ay be preferable to
start parenteral treatm ent straig h t aw ay (see pag e 1 3 5 ).
I n th e ev ent of failure of correctly ad m inistered treatm ent w ith a first line A C T , use
anoth er A C T or quinine P O .
quinine P O D 1 to D 7
C h ild ren and ad ults ≤ 5 0 kg : 3 0 m g / kg / d ay in 3 d iv id ed d oses at 8 -h our interv als
A d ults > 5 0 kg : 1 8 0 0 m g / d ay in 3 d iv id ed d oses at 8 -h our interv als
R ed uced susceptibility to quinine h as been observ ed in South -E ast A sia and A m azon
reg ion. I n th ese areas, quinine is g iv en in com bination w ith d oxycycline or
clind am ycin:
doxycycline P O D 1 to D 7
C h ild ren > 8 years and ad ults: 2 0 0 m g once d aily
or, in ch ild ren < 8 years:
clindamycin P O D 1 to D 7
2 0 m g / kg / d ay in 2 d iv id ed d oses
Note: P. falciparum is resistant to ch loroquine (C Q ) in A frica, South A m erica, South -E ast
A sia and O ceania but appears to rem ain sensitiv e to C Q in H aiti and th e D om inican
R epublic. I n th ese reg ions, C Q rem ains th e first line treatm ent ( see non- falciparum
m alaria, pag e 1 3 2 ).
Symptomatic treatment
– P aracetam ol P O in th e ev ent of h ig h fev er, see pag e 2 6 .
Treatment of severe malaria
T h e patient m ust be h ospitalised .
Antimalarial treatment (for preg nant w om en, see pag e 1 3 8 )
At dispensary level:
B efore transfer, ad m inister th e first d ose of artesunate or artem eth er I M (load ing d ose,
see below ) or one d ose of rectal artesunate:
Weight 50 mg artesunate suppository 200 mg artesunate suppository
3 -5 kg 1 –
6 -1 0 kg –
1 1 -2 0 kg 2 1
2 1 -4 0 kg – 2
4 1 -6 0 kg – 3
6 1 -8 0 kg – 4
–
At hospital level:
T h e d rug s of ch oice are artem isinin d eriv ativ es, ad m inistered by parenteral route:
artesunate IV or IM or, if injectable artesunate is not av ailable, artem eth er I M .
134
Notes:
I n infants below th e ag e/ w eig h t m entioned in th e table abov e, th ere is little d ata on
efficacy and safety of A C T s.
T h e com binations A L , A S- A Q and D H A - P P Q can be used . T h e d ose sh ould be
calculated so as to correspond to 1 0 -1 6 m g / kg / d ose of lum efantrine; 1 0 m g / kg / d ay of
am od iaquine; 1 6 -2 6 m g / kg / d ay of piperaquine).
T h e com bination A S-SP sh ould not be used d uring th e first w eeks of life.
C linical cond ition of young ch ild ren can d eteriorate rapid ly; it m ay be preferable to
start parenteral treatm ent straig h t aw ay (see pag e 1 3 5 ).
I n th e ev ent of failure of correctly ad m inistered treatm ent w ith a first line A C T , use
anoth er A C T or quinine P O .
quinine P O D 1 to D 7
C h ild ren and ad ults ≤ 5 0 kg : 3 0 m g / kg / d ay in 3 d iv id ed d oses at 8 -h our interv als
A d ults > 5 0 kg : 1 8 0 0 m g / d ay in 3 d iv id ed d oses at 8 -h our interv als
R ed uced susceptibility to quinine h as been observ ed in South -E ast A sia and A m azon
reg ion. I n th ese areas, quinine is g iv en in com bination w ith d oxycycline or
clind am ycin:
doxycycline P O D 1 to D 7
C h ild ren > 8 years and ad ults: 2 0 0 m g once d aily
or, in ch ild ren < 8 years:
clindamycin P O D 1 to D 7
2 0 m g / kg / d ay in 2 d iv id ed d oses
Note: P. falciparum is resistant to ch loroquine (C Q ) in A frica, South A m erica, South -E ast
A sia and O ceania but appears to rem ain sensitiv e to C Q in H aiti and th e D om inican
R epublic. I n th ese reg ions, C Q rem ains th e first line treatm ent ( see non- falciparum
m alaria, pag e 1 3 2 ).
Symptomatic treatment
– P aracetam ol P O in th e ev ent of h ig h fev er, see pag e 2 6 .
Treatment of severe malaria
T h e patient m ust be h ospitalised .
Antimalarial treatment (for preg nant w om en, see pag e 1 3 8 )
At dispensary level:
B efore transfer, ad m inister th e first d ose of artesunate or artem eth er I M (load ing d ose,
see below ) or one d ose of rectal artesunate:
Weight 50 mg artesunate suppository 200 mg artesunate suppository
3 -5 kg 1 –
6 -1 0 kg –
1 1 -2 0 kg 2 1
2 1 -4 0 kg – 2
4 1 -6 0 kg – 3
6 1 -8 0 kg – 4
–
At hospital level:
T h e d rug s of ch oice are artem isinin d eriv ativ es, ad m inistered by parenteral route:
artesunate IV or IM or, if injectable artesunate is not av ailable, artem eth er I M .
134
