MANAGEMENT OF MALARIA

 

NATIONAL MALARIA TREATMENT POLICY (2015)
Uncomplicated Malaria
All patients:
including children
<4 months of age and
pregnant women
in 2nd and 3rd
trimesters
First line medicine

  • Artemether/Lumefantrine

First line alternative

  • Artesunate/Amodiaquine

Second line medicine

  • Dihydroartemisin/
    Piperaquine
  • If not available: quinine tablets
Pregnant women 1st
trimester
  • Quinine tablets
  • ACT may be used if quinine not
    available
Severe Malaria
All age groups or
patient categories
First line

  • IV Artesunate

First line alternative

  • IV Quinine
  • Or Artemether injection

Pre-referral treatment

  • Rectal artesunate
Intermittent preventive treatment in pregnancy
Sulfadoxine/Pyrimethamine (SP) for IPT. Start at
13 weeks and give monthly till delivery

Treatment of uncomplicated malaria

The following tables contain dosages for medicines used in treatment of uncomplicated malaria.

Dosage of artemether/lumefantrine 20/120 mg

WEIGHT (KG) AGE DAY 1 DAY 2 DAY 3
5–14 4 months–
3 years
1 tab
twice
daily
1 tab
twice
daily
1 tab
twice
daily
15–24 3–7 years 2 tab
twice
daily
2 tab
twice
daily
2 tab
twice
daily
25–34 7–12 years 3 tab
twice
daily
3 tab
twice
daily
3 tab
twice
daily
35 > 12 years 4 tab
twice
daily
4 tab
twice
daily
4 tab
twice
daily

Note: Give doses every 12 hours

Dosage of artesunate (AS) tablets 50 mg once a day

AGE DAY 1 DAY 2 DAY 3
5–11
months
25 mg
(½ tab)
25 mg
(½ tab)
25 mg
(½ tab)
1–6 years 50 mg
(1 tab)
50 mg
(1 tab)
50 mg
(1 tab)
7–13 years 100 mg (2 tabs)
100 mg
(2 tabs)
100 mg
(2 tabs)
13 years 200 mg(4 tabs) 200 mg(4 tabs) 200 mg(4 tabs)

Note: Do not use artesunate alone, give with amodiaquine tabs

Dosage of amodiaquine (AQ) 153 mg tablets

 

AGE DAY 1 DAY 2 DAY 3
5–11
months
76 mg
(1/2 tab)
76 mg
(1/2 tab)
76 mg
(1/2 tab)
1–6 years 153 mg
(1 tab)
153 mg
(1 tab)
153 mg
(1tab)
7–13 years 306 mg
(2 tabs)
306 mg
(2 tabs)
306 mg
(2 tabs)
>13 years 612 mg
(4 tabs)
612 mg
(4 tabs)
612 mg
(4 tabs)
612 mg
(4 tabs)

Note: Do not use amodiaquine alone, use with artesunate tabs

Dosage of dihydroartemisinin (DHA)/Piperaquine tablets
(PPQ) (40/320 mg) tablets

 

WEIGHT (KG) AGE DAY 1 DAY 2 DAY 3
5–9.9 6 month–
1 year
0.5 0.5 0.5
10–20 2–7years 1 1 1
20–40 8–13 years 2 2< 2
≥ 40 ≥ 14 years 3 3 3

Dosage of quinine tablets (1 quinine tab = 300 mg salt)

WEIGHT
(KG)
AGE DOSE (TO BE GIVEN EVERY
8 HOURS FOR 7 DAYS)
5–1<0 3 months–1 year 75 mg (¼ tab)
10–18 1–5 years 150 mg (½ tab)
18–24 5–7 years 225 mg (¾ tab)
24–30 7–10 years 300 mg (1 tab)
30–40 10–13 years 375 mg (1¼ tab)
40–50 13–15 years 450 mg (1½ tab)
> 50 > 15 years 600 (2 tabs)

Management of severe malaria

General principles

  • Manage complications as recommended in the section below
  • Manage fluids very carefully. Adults with severe malaria are very vunerable to fluid overload, while children are more likely to be dehydrated
  • Monitor vitals signs carefully including urine output
  • Intravenous artesunate is the medicine of choice
    • At a health unit without admission and IV drug administration facilities, give a pre-referral dose of rectal artesunate ( see dosing tables below) as soon as possible and refer for further management
    • At a health unit with admission and IV drug administration facilities, treat with IV artesunate as in the table below
    • If IV route is not possible, use IM route
  • If artesunate not available, use IM artemether (into the thigh, never in the buttock) or IV quinine

Dosage of rectal artesunate in children

WEIGHT (KG) AGE ARTESUNATE
DOSE (MG)
REGIMEN
(SINGLE DOSE)
< 6 2–4 months 50 mg 1 supp (50 mg)
6–11.9 4 months-
2 years
100 mg 2 supp (50 mg)
12–19 2–5 years 150 mg 3 supp (50 mg)
20–29 6–10 years 200 mg 1 supp (200 mg)
30–39 10–13 years 300 mg 1 supp (200 mg)
+ 2 supp
(50 mg)
Note
  • In the event that an artesunate suppository is expelled from the rectum within 30 minutes of insertion, insert a repeat dose.
  • Hold the buttocks (especially in young children) together for 10 minutes to ensure retention of rectal dose

Dosage of rectal artesunate in adults

WEIGHT (KG) ARTESUNATE
DOSE
REGIMEN (SINGLE DOSE)
< 40 10 mg/kg
bodyweight
Use appropriate number of
rectal supp (see table above)
40–59 400 mg 2 supp of 200 mg
60–80 800 mg 4 supp of 200 mg
> 80 1200 mg 6 supp of 200 mg
> 80 1200 mg 6 supp of 200 mg

Dosage of intravenous artesunate for severe malaria

Artesunate IV
DOSE TIME QUANTITY
First dose: on admission
Loading dose
At 0 hours Child less than
20 kg: 3 mg/kg
Adults and child
>20kg: 2.4 mg/kg
Second dose At 12 hours
Third dose At 24 hours
Then once a day until patient is able to tolerate oral
medication, then give a full course of oral ACT

Preparation of IV or IM artesunate

  • IV artesunate is usually dispensed in powder vial of 60 mg, pre-packed with sodium bicarbonate solution 1 ml
  • Calculate the dose in mg according to the weight and the number of vials needed
  • Reconstitute each vial separately, and use within 1 hour
  • Reconstitution: inject all the content of the bicarbonate ampoule (1 ml) in the artesunate vial. Shake gently till solution become clear (discard if not clear after 2 minutes)

IV use

  • Dilution: dilute solution by adding 5 ml of sodium chloride 0.9% (normal saline) or Dextrose 5%, obtaining a concentration of 10 mg/ml
  • Calculate the required volume and withdraw
  • Give by IV injection slowly over 5 minutes

IM use

  • Dilution: dilute solution by adding 2 ml of sodium chloride 0.9%, obtaining a concentration of 20 mg/ml
    • Inject into the upper outer anterior thigh, NEVER in the buttock
    • DO NOT USE WATER FOR INJECTION FOR DILUTION

Dosage of IM artemether

Artemether
DOSE TIME QUANTITY
First dose: on admission
Loading dose
At 0 hours 3.2 mg/kg
Second dose At 24 hours 1.6 mg/kg
Third dose At 48 hours 1.6 mg/kg
Then once a day until patient is able to tolerate oral medication, then give a full course of oral ACT

Dosage of quinine IV

Dose
  • 10 mg/kg in dextrose 5% every 8 hours till
    patient is able to tolerate oral medication
  • Then complete with a full dose of ACT (3
    days) or quinine tablets to complete 7 days