Chinese guidelines for treatment
4.1 Treatment of Plasmodium vivax
4.1.1 Three-day chloroquine plus eight-day primaquine regimen
4.1.1.1 Chloroquine plus primaquine regimen for adults
Chloroquine plus primaquine: chloroquine total oral dose of 1,200 mg (8 tablets, each tablet containing chloroquine base 150 mg). 600 mg shall be taken orally on the first day, or 300 mg twice on the first day and 300 mg once on the second day and the third day respectively. The total oral dose of primaquine shall be 180 mg. From the first day of taking chloroquine, primaquine shall be taken at the same time, once a day, 22.5 mg (3 tablets) for 8 days.
4.1.1.2 Chloroquine plus primaquine regimen for children
For children under 15-year old, oral chroloquine at a total dose of 20 mg base /kg bw is given. Chroloquine is given at an initial dose of 10 mg base/ kg bw, followed by 5 mg base/kg bw on the second and third day. Oral primaquine at a total dose of 3 mg base/kg bw is given. Primaquine has been given for 8 days, from the first day of taking chloroquine, primaquine shall be taken orally 0.375 mg base /kg bw once a day for 8 days.
4.1.2 Three-day piperaquine phosphate (piperaquine for short) plus eight-day primaquine regimen
4.1.2.1 Piperaquine plus primaquine regimen for adults
The total dose of piperaquine1,200 mg base (8 tablets, each tablet containing piperaquine base 150 mg) and primaquine 180 mg base (24 tablets, each tablet containing primaquine base 7.5 mg).
Piperaquine shall be taken orally with 600 mg (4 tablets) on the 1 st day, or oral administration of 300 mg (2 tablets) twice on the 1 st day, 300 mg (2 tablets) on the 2nd day and 3rd day respectively.
From the first day of taking piperaquine, primaquine shall be taken orally, once a day, 22.5 mg (3 tablets) for 8 days.
4.1.2.2 Piperaquine plus primaquine regimen for children
For children under 15-year old, oral piperaquine at a total dose of 20 mg base /kg bw is given. Oral primaquine at a total dose of 3 mg base/kg bw is given. Piperaquine is given at an initial dose of 10 mg base/ kg bw, followed by 5 mg base/kg bw on the second and third day. From the first day of taking piperaquine, primaquine shall be taken orally 0.375 mg base /kg bw once a day for 8 days.
Note: The blood stages of P. oval, P.malariae and P. knowlesi should be treated as that for P. vivax. However, for P.malariae and P.knowlesi it does not need primaquine for preventing relapse.
4.2 The four ACTs recommended for treatment of uncomplicated
P.falciparum malaria
4.2.1 Dihydroartemisinin-piperaquine tablets
4.2.1.1 Dihydroartemisinin-piperaquine for adult.
The total dose shall be 8 tablets, each containing dihydroartemisinin 40 mg and piperaquine base 171.4 mg. The first oral dose shall be 2 tablets. In addition, 2 tablets are taken at 8, 24 and 32 h respectively.
4.2.1.2 Dihydroartemisinin-piperaquine for children
According to the age of the children and the dose of Table 3-1, they are taken orally at the first dose, 8, 24 and 32 h, respectively.
Table 3-1 Children’s dose of dihydroartemisinin piperaquine tablets
4.2.1.3 Other considerations
4.2.1.3.1 It is prohibited for patients who are allergic to any of the drug ingredients in this drug, the first trimester pregnancy, as well as patients with severe liver and kidney diseases, blood diseases (leukopenia, thrombocytopenia, etc.).
4.2.1.3.2 Use with caution in patients with hepatic and renal insufficiency.
4.2.1.3.3 Piperaquine has a long half-life and it should not be taken repeatedly within half a month.
4.2.2 Artemisinin-piperaquine tablets
The total oral dose shall be 4 tablets (each tablet contains artemisinin 62.5 mg, piperaquine 375 mg), 2 tablets each time, once a day for 2 days. (children’s regimen omit.
4.2.3 Artemisinin-naphthoquine tablets
A total oral dose of 8 tablets (each tablet contains naphthoquine 50 mg, artemisinin 125 mg) shall be taken all once a day. (regimen of children omit)
4.2.4 Artesunate-amodiaquine tablets
The total oral dose of artesunate-amodiquine 6 tablets ( each tablet contains artesunate 100 mg, amodiquine 270 mg), 2 tablets/day, once a day for 3 days. (regimen of children omit)(https://www.daowen.com)
4.3 Treatment of severe malaria (choose one of the following)
4.3.1 Artesunate injection
4.3.1.1 Artesunate injection treatment for adults
The first dose of artesunate shall be given with intravenous injection at 120 mg, followed by 120 mg at 12 and 24 hours respectively, once a day for 7 days. If the clinical symptoms and the patient signs are relieved and the patient can tolerate oral therapy, followed by a standard 3-day course of an ACT.
4.3.1.2 Artesunate injcction treatment for children
The artesunate was administered intravenouly at a dose of 3 mg/kg bw (in patients weighing ＜ 20kg) or 2.4 mg/kg bw (in those weighing ≥ 20 kg) at 0, 12, and 24 hours respectively, once a day for 7 days. If the clinical symptoms and signs of the patients are the patient relieved and can tolerate oral therapy, followed by a standard 3-day conrse of an ACT (children’s dose).
4.3.1.3 Other considerations
4.3.1.3.1 Preparing artesunate injection: 2 mL 5% sodium bicarbonate injection should be injected into artesunate powder and shaken gently for 2-3 minutes, after dissolution and clarification then 8 mL of 5% isomotic glucose solution or normal saline should be injected. In addition, it shall be mixed and slowly injected intravenously (not suitable for infusion).
4.3.1.3.2 Artesunate injection should be used as soon as possible after prepared. If the prepared solution is turbid, it cannot be used.
4.3.2 Artemether injection
4.3.2.1 Artemether injection cure for adult.
The initial dose of artemether is 160 mg (if the patient is in a coma or the density of parasite is ≥ 5%, 80 mg of artemether is given again after 6 hours) intramuscularly; then the maintenance dose is 80 mg daily for 6 days. If the patient’s clinical symptoms and signs are relieved and can tolerate oral therapy, complete treatment with 3 days of an ACT.
4.3.2.2 Artemether injection cure for children
The initial dose of artemether is 3.2 mg/kg bw intramuscularly, then the maintenance dose is 1.6 mg/kg bw daily for 6 days. If the clinical symptoms and signs of patients are relieved and they can tolerate oral therapy, complete treatment with 3 days of an ACT.
4.3.2.3 Other considerations
The drug may develop coagulation when it is cold; it can also be used after slightly warm dissolution.
4.3.3 Pyronaridine phosphate ( pyronaridine for short) injection
4.3.3.1 Pyronaridine cure for adults
The dose of pyronaridine is 160 mg with intravenous injection daily for 3 days. If the patient is in a serious condition (coma or the density of parasite is ≥ 5%), 160 mg can be injected again 6-8 hours after the initial dose. In addition, the total dose of pyronaridine does not exceed 640 mg.
4.3.3.2 Pyronaridine injection cure for adults: 160 mg/day intramuscularly daily for 3 days.
4.3.3.3 Pyronaridine injection cure for children
The pyronaridine dose of 3.2 mg/kg bw is given with intravenous or intramuscular injection daily, for 3 days.
4.3.3.4 Other considerations
During intravenous infusion, the 160 mg solution shall be added to 500ml of 5% glucose solution or 0.9% normal saline solution to mix well. In addition, the infusion speed is less than 60 drops/min.
4.4 Treatment of malaria in pregnant women
4.4.1 Pregnant women with non-P. falciparum malaria can be treated with chloroquine.
4.4.2 Pregnant women with uncomplicated P.falciparum malaria during the first trimester can be treated with piperaquine: the total dose is 1,500 mg, and the initial dose is 600 mg, twice a day; 450 mg will be given on the second and third day respectively.
4.4.3 The pregnant patients with uncomplicated P. falciparum malaria can be treated with ACT except the first trimester.
4.4.4 Pregnant women with severe malaria should be treated with artesunater or artemether injection.
4.5 Radical cure of Plasmodium vivax and ovale in liver stage
Primaquine: a total oral dose of 180 mg, once a day, 22.5 mg/ day for 8 days.
4.6 Preventive medication
Piperaquine tablets: take 600 mg once a month for adults, used in falciparum malaria and vivax malaria endemic areas.