WHO guidelines for treatment
Reference: Guideline for the Treatment of Malaria, third edition
5.1 Treatment guidelines for uncomplicated falciparum malaria
5.1.1 Artesunate + sulfadoxine-pyrimethamin.
5.1.2 Artemether + lumefantrine
5.1.3 Artesunate + amodiaquine
5.1.4 Artesunate + mefloquine
5.1.5 Dihydroartemisinin + piperaquine
A target dose (range) of 4 (2-10) mg/kg bw dihydroartemisinin per day and 18 (16-27) mg/kg bw piperaquine per day given once a day for 3 days for adults and children weighing ≥ 25 kg. The target doses and ranges for children weighing ＜ 25 kg are 4 (2.5-10) mg/kg bw dihydroartemisinin per day and 24 (20-32) mg/kg bw piperaquine per day once a day for 3 days.
5.1.6 Artesunate + pyronaridine
5.1.6.1 Artesunate 60 mg + pyronaridine180 mg/tablet for adults and children weighing ≥25kg, Orally for 3 days (days 0, 1 and 2), dosed according to body weight as follows:
5.1.6.2 Artesunate 20 mg + pyronaridine 60 mg /sachet for children weighing ＜ 25kg.
Orally for 3 days (days 0, 1 and 2), dosed according to bodyweight as follows:
5.2 Treatment guidelines for uncomplicated non-falciparum malaria with (https://www.daowen.com)
It is similar with Chinese guidelines except antirelapse treatment (omitted).
5.3 Radical cure Plasmodium vivax and ovale in liver stage
Primaquine: a total oral dose of 210 mg once a day, 15 mg/kg for 14 days.
5.4 Treatment guidelines for severe malaria
Treat adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women) with intravenous or intramuscular artesunate for at least 24h until they can tolerate oral medication. Once a patient has received at least 24h of parenteral therapy and can tolerate oral therapy, complete treatment with 3 days of an ACT.
5.4.1 The therapy of artesunate and artemether
Children weighing less than 20 kg should receive a higher parenteral dose of artesunate (3 mg/kg/dose) than larger children and adults (2.4 mg/kg/dose) to ensure equivalent drug exposure for 7 days.The initial dose of artemether is 3.2 mg/kg bw intramuscularly (to the anterior thigh); the maintenance dose is 1.6 mg/kg bw intramuscularly daily for 7 days.
5.4.2 The therapy of quinine dihydrochloride-intravenous infusion
The peak concentration after intramuscular quinine in severe malaria are similar to those after intravenous infusion; quinine dihydrochloride shall be diluted to a concentration of 60-100 mg/mL intravenous infusion with 5% glucose (original concentration 300 mg/mL); the first dose is the most important in the treatment of severe malaria. It should be reduced only if there is clear evidence of adequate pre-treatment before presentation. The first dose is 10 mg/kg bw; the maintenance dose of quine (10 mg salt/kg bw) is administered at 8 hours intervals, starting 8 hours after the first dose. If there is no improvement in the patient’s condition within 48 hours, the dose should be reduced by one third. i.e. 10 mg salt/kg bw every 12 hours.
5.4.3 The therapy of quinine dihydrochloride-intramuscular injection
The site of intramuscular injection: in front of the thigh; quinine should not be injected into the buttocks to avoid sciatic nerve injury; the first dose should be split, with 10 mg/kg bw each thigh, the rest is similar with quinine dihydrochloride intravenous infusion.
5.4.4 Other considerations
Undiluted quinine dihydrochloride at a concentration of 300 mg/mL is acidic (pH 2) and painful when given by intramuscular injection, so it is best to administer it either in a buffered formulation or diluted to a concentration of 60-100 mg/mL for intramuscular injection. Gluconate salts are less acidic and better tolerated than the dihydrochloride salt when given by the intramuscular and rectal routes. The first dose is the most important dose for the treatment of severe malaria. It should be reduced only if there is clear evidence of adequate pre-treatment before presentation. Although quinine can cause hypotension if administered rapidly, and overdose is associated with blindness and deafness, these adverse effects are rare in the treatment of severe malaria. The dangers of insufficient treatment (i.e. death from malaria) exceed those of excessive initial treatment.
5.5 Treatment of malaria in pregnant women
5.5.1 Treat pregnant women with uncomplicated P. falciparum malaria during the first trimester with 7 days of quinine + clindamycin.
5.5.2 Treat pregnant wormen in all trimesters with severe malaria with intravenous or intramuscular artesunate for at least 24h until they can tolerate oral medication.
5.5.3 In the second and third trimester it may treat with 3 days of an ACT .
5.5.4 Intermittent preventive treatment in pregnancy (IPTp)
In malaria-endemic areas in Africa, provide SP-IPTp to all women in their first or second pregnancy as part of antenatal care. Dosing should start in the second trimester and doses should be given at least 1 month apart, with the objective of ensuring that at least three doses are received.