Treatment of Malaria in the United States
Preferences | Drug a | Adult Dosage | Pediatric Dosage b |
|---|---|---|---|
Uncomplicated malaria due to P. falciparum | |||
Recommended drug | c | 6 doses (1 dose = 4 tablets) over 3 days (at 0 and 8 hours), then 1 dose twice a day for the following 2 days | 6 doses at intervals as for the adults; dose = 5–< 15 kg: 1 tablet 15–< 25 kg: 2 tablets 25–< 35 kg: 3 tablets ≥ 35 kg: 4 tablets |
or | |||
d | 4 adult tablets once a day for 3 days | < 5 kg: Not indicated 5–8 kg: 2 pediatric tablets once a day for 3 days 9–10 kg: 3 pediatric tablets once a day for 3 days 11–20 kg: 1 adult tablet once a day for 3 days 21–30 kg: 2 adult tablets once a day for 3 days 31–40 kg: 3 adult tablets once a day for 3 days > 40 kg: 4 adult tablets once a day for 3 days | |
or | |||
plus one of the following: | 650 mg 3 times a day for 3 or 7 days e | 10 mg/kg 3 times a day for 3 or 7 dayse Dose not to exceed adult dose | |
| 100 mg twice a day for 7 days | 2.2 mg/kg twice a day for 7 days | |
| 250 mg 4 times a day for 7 days | 6.25 mg/kg 4 times a day for 7 days | |
| 7 mg/kg 3 times a day for 7 days | 7 mg/kg 3 times a day for 7 days | |
Alternative (if other options cannot be used) | h | 750 mg once, then 500 mg 6–12 hours later | 15 mg/kg once, then 10 mg /kg 6–12 hours later |
Additional options for uncomplicated malaria due to P. falciparumP. malariae and P. knowlesi in all regions. If the unidentified species could be P. vivax or P. ovale | |||
Drugs i | |||
j,k | 1,000 mg, then 500 mg at 6, 24, and 48 hours | 16.6 mg/kg (up to 1000 mg), then 8.3 mg/kg (up to 500 mg) at 6, 24, and 48 hours | |
or | |||
k | 800 mg, then 400 mg at 6, 24, and 48 hours | 13 mg/kg (up to 800 mg), then 6.5 mg/kg (up to 400 mg) at 6, 24, and 48 hours | |
or | |||
c | Dosing above | Dosing above | |
Uncomplicated malaria due to P. vivaxP. ovale in all regions—Oral drugs | |||
Recommended drugs i | j,kor k | Dosing as above | Dosing as above |
plus | |||
l,m | 30 mg once a day for 14 days | 0.5 mg/kg (maximum 30 mg) once a day for 14 days | |
or | |||
l,m | 300 mg single dose | For patients ≥ 16 years, adult dose | |
Uncomplicated malaria due to P. vivaxP. vivax m (Papua New Guinea, Indonesia)—Oral drugs | |||
Recommended drugs | c | Dosing above | Dosing above |
or | |||
d | 4 adult tablets once a day for 3 days | < 5 kg: Not indicated 5–8 kg: 2 pediatric tablets once a day for 3 days 9–10 kg: 3 pediatric tablets once a day for 3 days 11–20 kg: 1 adult tablet once a day for 3 days 21–30 kg: 2 adult tablets once a day for 3 days 31–40 kg: 3 adult tablets once a day for 3 days > 40 kg: 4 adult tablets once a day for 3 days | |
or | |||
plus one of the following: | 650 mg 3 times a day for 3 or 7 days e | 10 mg/kg 3 times a day for 3 or 7 days e | |
| 100 mg twice a day for 7 days | 2.2 mg/kg twice a day for 7 days | |
| 250 mg 4 times a day for 7 days | 6.25 mg/kg 4 times a day for 7 days | |
or | |||
h | 750 mg once, then 500 mg 6–12 hours later | 15 mg/kg once, then 10 mg/kg 6–12 hours later | |
plus, with any of the above regimens | |||
l | 30 mg once a day for 14 days | 0.5 mg/kg (maximum 30 mg) once a day for 14 days | |
or | |||
l | 300 mg single dose | For patients ≥ 16 years, adult dose | |
Severe malarian, all Plasmodium —Parenteral drugs | |||
Recommended drugs | |||
n, commercially available, but if it cannot be obtained within 24 hours, contact the CDC Malaria Hotline o | Adults 2.4 mg/kg actual body weight IV at 0, 12, 24, and 48 hours | Children < 20 kg: 3 mg/kg actual body weight IV at 0, 12, 24, and 48 hours Children ≥ 20 kg: adult dose | |
Reassess parasite density 4 or more hours after third dose. When parasite density is < 1% and patient able to tolerate oral therapy, start oral treatment with one of the following: | |||
Artemether-lumefantrine (preferred) | Dosing as above | Dosing as above | |
d | Dosing as above | Dosing as above | |
f | Dosing as above; same dose may also be given IV | ||
g,p (in children < 8 years and pregnant women) | Oral dosing as above, but if parenteral therapy is required, give 10 mg/kg IV loading dose followed by 5 mg/kg IV every 8 hours | Oral dosing as above, but if parenteral therapy is required, give 10 mg/kg IV loading dose followed by 5 mg/kg IV every 8 hours | |
plus, if P. vivax or P. ovale is likely or confirmed | |||
l | 30 mg once a day for 14 days after leaving the endemic area | 0.5 mg/kg once a day (maximum 30 mg) for 14 days after leaving the endemic area | |
l | 300 mg single dose | Only for patients ≥ 16 years, use adult dose | |
a See table Drugs Used to Prevent Malaria for adverse reactions and contraindications. If malaria has developed during prophylactic drug therapy, that drug should not be used as part of the treatment regimen. | |||
b The pediatric dose should not exceed the adult dose. | |||
c | |||
d< 30 mL/min. Generally, this combination is not recommended for pregnant women, particularly during the 1st trimester, because safety data are insufficient; it may be used if other options are unavailable or are not tolerated and benefits outweigh risks. Twice a day dosing reduces nausea and vomiting as does taking it with food or milk. If patients vomit within 30 min of taking a dose, the dose should be repeated. | |||
e | |||
f Use of tetracyclines is not recommended during pregnancy and in children < | |||
g< 8 years. | |||
h | |||
i Any of the drug regimens recommended for P. falciparumP. ovale or P. vivax | |||
j | |||
k | |||
lP. vivax and P. ovale | |||
m If patients acquire P. vivaxP. vivaxP. vivax regimen, and clinicians should call the CDC Malaria Hotline. | |||
nP. falciparum | |||
o The CDC Malaria Hotline is available at 770-488-7788 or 855-856-4713 toll-free Monday-Friday 9AM to 5PM EST (after hours, weekends, or holidays, 770-488-7100). | |||
p | |||
G6PD = glucose-6-phosphate dehydrogenase; CDC = Centers for Disease Control and Prevention | |||
Adapted from the CDC: Malaria diagnosis and treatment in the United States. | |||