Standard treatment for uncomplicated malaria

Treatment regimens for uncomplicated malaria are shown below. For patients with P. falciparum malaria, see also Additional considerations for P. falciparum. For patients with P. vivax or P. ovale malaria, see also Additional considerations for P. vivax and P. ovale.

Use:

1 artemether+lumefantrine tablets 20+120 mg, to be taken with fatty food or full-fat milk for a total of six doses¹ malaria, uncomplicated artemether + lumefantrine

adult and child more than 34 kg: 4 tablets orally, at 0, 8, 24, 36, 48 and 60 hours. For dosage adjustment in adults with kidney impairment, see artemether+lumefantrine dosage adjustment

child 5 to 14 kg: 1 tablet orally, at 0, 8, 24, 36, 48 and 60 hours

child 15 to 24 kg: 2 tablets orally, at 0, 8, 24, 36, 48 and 60 hours

child 25 to 34 kg: 3 tablets orally, at 0, 8, 24, 36, 48 and 60 hours

OR

2 atovaquone+proguanil tablets 250+100 mg (adult formulation), to be taken with fatty food or full-fat milk malaria, uncomplicated atovaquone + proguanil

adult and child more than 40 kg: 4 tablets orally, daily for 3 days. For dosage adjustment in adults with kidney impairment, see atovaquone+proguanil dosage adjustment

child 11 to 20 kg: 1 tablet orally, daily for 3 days

child 21 to 30 kg: 2 tablets orally, daily for 3 days

child 31 to 40 kg: 3 tablets orally, daily for 3 days

OR the combination of

3 quinine sulfate 600 mg (adult less than 50 kg: 450 mg) (child: 10 mg/kg up to 600 mg) orally, 8-hourly for 7 days² malaria, uncomplicated quinine sulfate quinine quinine

PLUS EITHER

doxycycline orally, 12-hourly for 7 days (which can start after day 1 of quinine therapy)³ malaria, uncomplicated doxycycline

adult: 100 mg

child less than 21 kg: 2.2 mg/kg⁴

child 21 to less than 26 kg: 50 mg

child 26 to 35 kg: 75 mg

child more than 35 kg: 100 mg

OR (for children in whom a suitable formulation of doxycycline is not available or for pregnant women)

clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally, 8-hourly for 7 days. malaria, uncomplicated clindamycin

Monitor parasite count daily until negative.

Perform full blood count and malaria microscopy at 7 and 28 days after completion of therapy, to assess for recrudescence of malaria parasites.

¹ Recurrent Plasmodium malariae has occurred after artemether+lumefantrine therapy. In these patients, consider therapy with chloroquine or hydroxychloroquine—seek expert advice. Chloroquine is not registered in Australia but is available via the Special Access Scheme. Return

² Both quinine sulfate and quinine bisulfate are available as 300 mg tablets. Quinine sulfate 600 mg is approximately equivalent to quinine bisulfate 900 mg. Although the Australian Therapeutic Goods Administration (TGA) lists quinine as Category D in pregnancy, quinine has been used extensively in pregnant women to treat P. falciparum malaria. Return

³ An oral liquid formulation of doxycycline is not marketed in Australia but is available via the Special Access Scheme. For formulation options for children or people with swallowing difficulties, see Don't Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMsplus.Return

⁴ When used short term (eg less than 21 days), doxycycline has not been associated with tooth discolouration, enamel hypoplasia or bone deposition so can be used in children of all ages.Return