Page 33 - 80 guidelines for the treatment of malaria_opt

7. Treatment of uncomplicated P. falciparum malaria

box 7.4
Summary of recommendations on treatment for uncomplicated P. falciParum malaria

 the treatment of choice for uncomplicated falciparum malaria is a combination of two or more
antimalarial medicines with different mechanisms of action.
 acts are the recommended treatments for uncomplicated falciparum malaria.
 the artemisinin derivative components of the combination must be given for at least three days
for an optimum effect.
 the following acts are recommended:
• artemether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine, artesunate
plus sulfadoxine-pyrimethamine, and dihydrortemisinin plus piperaquine.
 fixed-dose combinations are highly preferable to the loose individual medicines co-blistered or
co-dispensed.
 the choice of act in a country or region will be based on the level of resistance of the partner
medicine in the combination:
• in areas of multidrug resistance (east Asia), artesunate plus mefloquine, or artemether plus lumefantrine
or dihydroartemisinin plus piperaquine are recommended; and
• in other areas without multidrug resistance (mainly Africa), any of the ACTs including those containing
amodiaquine or sulfadoxine-pyrimethamine may still be effective.

 artemisinin and its derivatives should not be used as monotherapy.
 second-line antimalarial treatment:
• alternative ACT known to be effective in the region;
• artesunate plus tetracycline or doxycycline or clindamycin, any of these combinations should be given
for 7 days;
• quinine plus tetracycline or doxycycline or clindamycin, any of these combinations should be given for
7 days.

7.5 practical aspects of treatment with recommended acts

An increasing variety of formulations and products are available for the recommended
artemisinin-based drug combinations. The drug concentrations achieved in an individual
patient depend on variables that include the pharmacokinetic properties of the drug, drug
quality, and dose taken related to dosing schedules and adherence.

7.5.1 Artemether plus lumefantrine
This is currently available as a fixed-dose formulation with dispersible or standard tablets
containing 20 mg of artemether and 120 mg of lumefantrine.
19