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aria
A fter th e initial treatm ent w ith parenteral artesunate or artem eth er, ad m inister a 3 -d ay
course of A C5T (see uncomplicated falciparum malaria, pag e 1 3 2 ).
or
quinine I V (th e d ose is expressed in quinine salt):
– L oad ing d ose: 2 0 m g / kg to be ad m inistered ov er 4 h ours, th en, keep th e v ein open
w ith an infusion of 5 % g lucose ov er 4 h ours; th en
– M aintenance d ose: 8 h ours after th e start of th e load ing d ose, 1 0 m g / kg ev ery 8 h ours
(alternate quinine ov er 4 h ours and 5 % g lucose ov er 4 h ours).
F or ad ults, ad m inister each d ose of quinine in 2 5 0 m l of g lucose. F or ch ild ren und er
2 0 kg , ad m inister each d ose of quinine in a v olum e of 1 0 m l/ kg of g lucose.
D o not ad m inister a load ing d ose to patients w h o h av e receiv ed oral quinine,
m efloquine or h alofantrine w ith in th e prev ious 2 4 h ours: start w ith m aintenance d ose.
A s soon as th e patient can tolerate oral treatm ent, ad m inister eith er a 3 -d ay course of
A C 5T or oral quinine (± d oxycycline or clind am ycin, see pag e 1 3 4 ) to com plete 7 d ays
of treatm ent.
If th e com bination A S-M Q is used as oral com pletion treatm ent follow ing IV quinine,
an interv al of 1 2 h ours sh ould elapse betw een th e last d ose of quinine and th e
ad m inistration of M Q .
Note: in isolated areas, w h en it is absolutely im possible to transfer a patient to a facility
w h ere parenteral antim alarial treatm ent can be ad m inistered , artesunate suppositories
m ust be ad m inistered once d aily, until th e patient is able to take a 3 -d ay course of A C T .
Symptomatic treatment and management of complications
Hydration
M aintain ad equate h yd ration. A s a g uid e, v olum e to be ad m inistered per 2 4 h ours by
oral or IV route:
Weight 5 to 9 kg 10 to 19 kg 20 to 29 kg ≥ 30 kg
T otal v olum e/ 2 4 h ours 1 2 0 m l/ kg 8 0 m l/ kg 6 0 m l/ kg 5 0
m l/ kg 8 0 m l/ kg 6 0 m l/ kg 5 0 m l/ kg 4 0
T otal v olum e/ 2 4 h ours
if associated sev ere pneum onia
m l/ kg
or neurolog ical sym ptom s
A d just th e v olum e accord ing to clinical cond ition in ord er to av oid d eh yd ration or fluid
ov erload (risk of pulm onary oed em a).
W h en th e IV route is used , ad m inister ½ 0 .9 % sod ium ch lorid e com bined w ith ½
10%
g lucose.
T reat d eh yd ration, if present (pag es 3 1 6 to 3 2 1 ).
Fever
– P aracetam ol in th e ev ent of h ig h fev er, see pag e 2 6 .
Sevepreenasnaatioenm)ia.
– B lood transfusion is ind icated :
• I n ch ild ren w ith H b < 4 g / d l ( or betw een 4 and 6 g / d l w ith sig ns of d ecom -
6
•DoInnpotreusgenAaSn-Mt wQ ifotmhe peantiewnt diethvelHopebd Cwlineiceakl ssigns of decompensation may include: shock, impaired consciousness or respiratory distress (acidosis).
or later).
5
6
A fter th e initial treatm ent w ith parenteral artesunate or artem eth er, ad m inister a 3 -d ay
course of A C5T (see uncomplicated falciparum malaria, pag e 1 3 2 ).
or
quinine I V (th e d ose is expressed in quinine salt):
– L oad ing d ose: 2 0 m g / kg to be ad m inistered ov er 4 h ours, th en, keep th e v ein open
w ith an infusion of 5 % g lucose ov er 4 h ours; th en
– M aintenance d ose: 8 h ours after th e start of th e load ing d ose, 1 0 m g / kg ev ery 8 h ours
(alternate quinine ov er 4 h ours and 5 % g lucose ov er 4 h ours).
F or ad ults, ad m inister each d ose of quinine in 2 5 0 m l of g lucose. F or ch ild ren und er
2 0 kg , ad m inister each d ose of quinine in a v olum e of 1 0 m l/ kg of g lucose.
D o not ad m inister a load ing d ose to patients w h o h av e receiv ed oral quinine,
m efloquine or h alofantrine w ith in th e prev ious 2 4 h ours: start w ith m aintenance d ose.
A s soon as th e patient can tolerate oral treatm ent, ad m inister eith er a 3 -d ay course of
A C 5T or oral quinine (± d oxycycline or clind am ycin, see pag e 1 3 4 ) to com plete 7 d ays
of treatm ent.
If th e com bination A S-M Q is used as oral com pletion treatm ent follow ing IV quinine,
an interv al of 1 2 h ours sh ould elapse betw een th e last d ose of quinine and th e
ad m inistration of M Q .
Note: in isolated areas, w h en it is absolutely im possible to transfer a patient to a facility
w h ere parenteral antim alarial treatm ent can be ad m inistered , artesunate suppositories
m ust be ad m inistered once d aily, until th e patient is able to take a 3 -d ay course of A C T .
Symptomatic treatment and management of complications
Hydration
M aintain ad equate h yd ration. A s a g uid e, v olum e to be ad m inistered per 2 4 h ours by
oral or IV route:
Weight 5 to 9 kg 10 to 19 kg 20 to 29 kg ≥ 30 kg
T otal v olum e/ 2 4 h ours 1 2 0 m l/ kg 8 0 m l/ kg 6 0 m l/ kg 5 0
m l/ kg 8 0 m l/ kg 6 0 m l/ kg 5 0 m l/ kg 4 0
T otal v olum e/ 2 4 h ours
if associated sev ere pneum onia
m l/ kg
or neurolog ical sym ptom s
A d just th e v olum e accord ing to clinical cond ition in ord er to av oid d eh yd ration or fluid
ov erload (risk of pulm onary oed em a).
W h en th e IV route is used , ad m inister ½ 0 .9 % sod ium ch lorid e com bined w ith ½
10%
g lucose.
T reat d eh yd ration, if present (pag es 3 1 6 to 3 2 1 ).
Fever
– P aracetam ol in th e ev ent of h ig h fev er, see pag e 2 6 .
Sevepreenasnaatioenm)ia.
– B lood transfusion is ind icated :
• I n ch ild ren w ith H b < 4 g / d l ( or betw een 4 and 6 g / d l w ith sig ns of d ecom -
6
•DoInnpotreusgenAaSn-Mt wQ ifotmhe peantiewnt diethvelHopebd
or later).
5
6
