Version October 2024
| Type of infection* | Trimester | Drug and dose |
| Chloroquine-resistant infection | First trimester | Preferred regimen |
| Artemether-lumefantrine:¶ 1 tablet = 20 mg artemether and 120 mg lumefantrine. A 3-day treatment schedule with a total of 6 oral doses is recommended based on weight (25 to 34 kg: 3 tablets per dose; ≥35 kg: 4 tablets per dose). The patient should receive the initial dose, followed by the second dose 8 hours later, then 1 dose orally twice daily for the following 2 days. Take after a full meal or whole milk. | ||
| Alternative regimens (if artemether-lumefantrine is unavailable or associated with treatment failure) | ||
One of the following:
or
plus
If no other options:
| ||
| Second or third trimester | One of the following:
or
If no other options:
| |
| Chloroquine-sensitive infection | First trimester | Chloroquine:
or Hydroxychloroquine:
or Artemether-lumefantrine:¶ 1 tablet = 20 mg artemether and 120 mg lumefantrine. A 3-day treatment schedule with a total of 6 oral doses is recommended based on weight (25 to 34 kg: 3 tablets per dose; ≥35 kg: 4 tablets per dose). The patient should receive the initial dose, followed by the second dose 8 hours later, then 1 dose orally twice daily for the following 2 days. Take after a full meal or whole milk. or Other artemisinin combination therapy (one of the following [dosing above]):
|
| Second or third trimester | Chloroquine or hydroxychloroquine (dosing above) or Artemisinin combination therapy (one of the following [dosing above]):
| |
| Anti-relapse therapy (for infections with P. vivax or P. ovale) | Refer to UpToDate text | |
ACT: artemisinin combination therapy; CDC: United States Centers for Disease Control and Prevention; G6PD: glucose-6-phosphate dehydrogenase; WHO: World Health Organization.
* The approach to antimalarial selection depends on a number of factors including species diagnosis and likelihood of chloroquine resistance. Preferred regimens for treatment of chloroquine-resistant non-falciparum malaria consist of ACT. Preferred regimens for treatment of chloroquine-sensitive non-falciparum malaria consist of chloroquine or ACT. If an antimalarial is taken for chemoprophylaxis, a different drug should be used for treatment.
¶ Among the ACTs, artemether-lumefantrine has been associated with the most favorable safety data in pregnancy. Refer to related UpToDate content for further discussion.
Δ Piperaquine component prolongs the QT interval by approximately the same amount as chloroquine but by less than quinine; avoid use in patients with congenital QT prolongation or who are on medications that prolong the QT interval. Dihydroartemisinin-piperaquine may be taken with food but should not be taken with a high-fat meal.
◊ For infections acquired in Southeast Asia, quinine treatment should continue for 7 days. For infections acquired in Africa and South America, quinine treatment should continue for 3 days. In the United States, quinine is encapsulated in a 324 mg (sulfate salt) dose; therefore, for adult dosing, 2 capsules are sufficient.
§ Mefloquine should be used only if other options are not available, and it is not recommended for children <15 kg or in patients with neuropsychiatric history. In addition, treatment with mefloquine is not recommended for patients who have acquired infection from Southeast Asia, due to drug resistance. The dosing regimen for mefloquine above is in alignment with the WHO[1], which differs from the CDC approach[2]; the WHO approach is associated with greater bioavailability and is better tolerated[3]. In the United States and Canada, pill strengths for mefloquine are labeled in hydrochloride salt; in many other countries, pill strengths are labeled in mefloquine base. 250 mg mefloquine hydrochloride (salt) is equivalent to 228 mg mefloquine base. Tablets can be crushed and mixed with small amount of milk or soft food before administration if needed.
¥ The dosing for chloroquine summarized in the table is based on the recommendations of the CDC. The dosing for chloroquine recommended by the WHO consists of the following: Total dose: 25 mg base/kg, administered as 10 mg base/kg orally on day 1 followed by 10 mg/kg orally on day 2, and 5 mg/kg base on day 3.Do you want to add Medilib to your home screen?
