Disease severity | Adult dosing | Pediatric dosing |
Mild to moderate disease (ambulatory patients)*¶Δ | ||
Preferred regimen | Azithromycin
| Azithromycin
|
PLUS | PLUS | |
Atovaquone◊
| Atovaquone◊
| |
Alternative regimen§ | Clindamycin
| Clindamycin
|
PLUS | PLUS | |
Quinine sulfate¥
| Quinine sulfate¥
| |
Severe acute disease (hospitalized patients): Initial management‡ | ||
Preferred regimen | Azithromycin†
| Azithromycin**
|
PLUS | PLUS | |
Atovaquone◊
| Atovaquone◊
| |
Alternative regimen§ | Clindamycin
| Clindamycin
|
PLUS | PLUS | |
Quinine sulfate¥
| Quinine sulfate¥
| |
Severe acute disease (hospitalized patients): Step-down therapy (eg, once symptoms have improved and parasitemia has declined)¶¶ | ||
Preferred regimen | Azithromycin
| Azithromycin
|
PLUS | PLUS | |
Atovaquone◊
| Atovaquone◊
| |
Alternative regimen | Clindamycin
| Clindamycin
|
PLUS | PLUS | |
Quinine sulfate¥
| Quinine sulfate¥
| |
Highly immunocompromised patientsΔΔ | ||
Begin as summarized above for patients with severe acute disease, then continue with a step-down regimen once symptoms have improved and parasitemia has declined. When oral azithromycin is used, a higher dose (500 to 1000 mg orally once daily) may be administered. Highly immunocompromised patients should be treated for at least 6 consecutive weeks, including 2 final weeks during which parasites are no longer detected on peripheral blood smear. |
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