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Guidelines for the treatment of malaria – 2 edition

Second and third trimesters:
■ ACTs known to be effective in the country/region or artesunate plus clindamycin to be given for
7 days, or quinine plus clindamycin to be given for 7 days.
 Lactating women:
■ lactating women should receive standard antimalarial treatment (including ACTs) except for dapsone,
primaquine and tetracyclines.
 Infants and young children:
■ ACTs for first-line treatment in infants and young children with attention to accurate dosing and ensuring
the administered dose is retained.
 Travellers returning to non-endemic countries:
■ atovaquone-proguanil;
■ artemether-lumefantrine;
■ quinine plus doxycycline or clindamycin.

TreaTmenT of severe malaria

 Severe malaria is a medical emergency. After rapid clinical assessment and confirmation of
the diagnosis, full doses of parenteral antimalarial treatment should be started without delay
with whichever effective antimalarial is first available.
 For adults, artesunate IV or IM:
■ artemether or quinine is an acceptable alternative if parenteral artesunate is not available.
 For children, artesunate IV or IM
■ artemether or quinine is an acceptable alternative if parenteral artesunate is not available.
 Give parenteral antimalarials in the treatment of severe malaria for a minimum of 24 h, once
started (irrespective of the patient’s ability to tolerate oral medication earlier) and, thereafter,
complete treatment by giving a complete course of:
■ an ACT;
■ artesunate plus clindamycin or doxycycline;
■ quinine plus clindamycin or doxycycline.
 If complete treatment of severe malaria is not possible, patients should be given pre-referral
treatment and referred immediately to an appropriate facility for further treatment. The following
are options for pre-referral treatment : rectal artesunate, quinine IM, artesunate IM, artemether IM.

TreaTmenT of uncomplicaTed P. vivax malaria
 Chloroquine combined with primaquine is the treatment of choice for chloroquine-sensitive
infections.
 In mild-to-moderate G6PD deficiency, primaquine 0.75 mg base/kg body weight given once a week
for 8 weeks. In severe G6PD deficiency, primaquine is contraindicated and should not be used.
 Where ACT (exception AS+SP) has been adopted as the first-line treatment for P. falciparum
malaria, it may also be used for P. vivax malaria in combination with primaquine for radical cure.
Artesunate plus sulfadoxine-pyrimethamine is not effective against P. vivax in many places.

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