Table 1 Current treatment of Plasmodium malaria infection
P. falciparum Uncomplicated | First-line treatment Artesunate + sulfadoxine pyrimethamine 50 mg or 100 mg of artesunate and tablets containing 500 mg of sulfadoxine + 25 mg of pyrimethamine Artesunate + mefloquine/amodiaquine Recommended if the use of sulfadoxine–pyrimethamine (SP) is contraindicated. Artesunate 15–20 mg/kg and mefloquine 8 (5–11) mg/kg/dose daily for 3 days Primaquine (0.25 mg base/kg body weight, maximum dose 15 mg) is recommended for uncomplicated P. falciparum malaria as gametocytocidal Second-line treatment Artemether–lumefantrine Available as tablets coartem (20 mg artemether and 120 mg lumefantrine) twice daily for 3 days Primaquine (0.25 mg base/kg body weight, maximum dose 15 mg) is recommended for uncomplicated falciparum malaria as gametocytocidal Third line treatment In case of contraindication with first line and second line the third line treatment is recommended as Atovaquone 250 mg/proguanil 100 mg (malarone) tablets daily for 3 days Quinine + doxycycline for 7 days Quinine and clindamycin is the preferred for pregnant women during first trimester |
P. falciparum (Special risk groups) | Pregnancy (first trimester): quinine + clindamycin for 7 days Infants (< 5 kg body weight): ACT (mg/kg) as given to the children of 5 kg body weight Malaria co-infected with HIV: avoid artesunate + sulfadoxine pyrimethamine if patient is on clotrimazole Avoid artesunate + amodiaquine if patient is on efavirenz or zidovudine |
P. falciparum Severe malaria | Artesunate through intravenous (IV) or intramuscular (IM) route for atleast 24 h or until patient become in condition to take oral medication. After 24 h ACT treatment for 3 days (primaquine can be added) In absence of IV/IM artesunate, artemether should be preferred |
P. vivax | P. vivax: chloroquine 25 mg for 3 days, in combination with primaquine 0.25 mg/kg and 15 mg for adults for 14 days in case of chloroquine-sensitive P. vivax malaria. Other ACTs should be combined with primaquine for chloroquine-resistant |
P. ovale | P. ovale: treatment recommended for P. ovale malaria infection is same as for P. vivax malaria |
P. malariae and knowlesi | P. malariae and P. knowlesi: infection is recommended for chloroquine like P. vivax malaria. No radical cure is required since, no hypnozoites are formed in infection |