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Guidelines for the treatment of malaria – 2 edition

Therapeutic dose. The recommended treatment is a 6-dose regimen over a 3-day period.
The dosing is based on the number of tablets per dose according to pre-defined weight
bands (5–14 kg: 1 tablet; 15–24 kg: 2 tablets; 25–34 kg: 3 tablets; and > 34 kg: 4 tablets),
given twice a day for 3 days. This extrapolates to 1.7/12 mg/kg body weight of artemether
and lumefantrine, respectively, per dose, given twice a day for 3 days, with a therapeutic
dose range of 1.4–4 mg/kg of artemether and 10–16 mg/kg of lumefantrine.
An advantage of this combination is that lumefantrine is not available as a monotherapy,
and it has never been used by itself for the treatment of malaria. Lumefantrine absorption
is enhanced by co-administration with fat. It is essential that patients or caregivers are
informed of the need to take this ACT immediately after a meal or drink containing
at least 1.2 g fat – particularly on the second and third days of treatment. A flavoured
dispersible tablet paediatric formulation of artemether plus lumefantrine is now available,
enhancing its use in young children (see details in Annex 3, sections A3.6.2, A3.7).

7.5.2 Artesunate plus amodiaquine

This is currently available as a fixed-dose formulation with tablets containing 25/67.5 mg,
50/135 mg or 100/270 mg of artesunate and amodiaquine. Blister packs of separate scored
tablets containing 50 mg of artesunate and 153 mg base of amodiaquine, respectively,
are also available.
Therapeutic dose. A target dose of 4 mg/kg/day artesunate and 10 mg/kg/day amodiaquine
once a day for 3 days, with a therapeutic dose range between 2–10 mg/kg/day artesunate
and 7.5–15 mg/kg/dose amodiaquine.
This combination was sufficiently efficacious only where 28-day cure rates with
amodiaquine monotherapy exceeded 80%. Resistance is likely to worsen with continued
availability of chloroquine and amodiaquine monotherapies (see Annex 3, Sections A3.2,
A3.6.3).

7.5.3 Artesunate plus mefloquine

This is currently available as blister packs with separate scored tablets containing 50 mg
of artesunate and 250 mg base of mefloquine, respectively. A fixed-dose formulation of
artesunate and mefloquine is at an advanced stage of development.
Therapeutic dose. A target dose of 4 mg/kg/day artesunate given once a day for 3 days
and 25 mg/kg of mefloquine either split over 2 days as 15mg/kg and 10mg/kg or over
3 days as 8.3 mg/kg/day once a day for 3 days. The therapeutic dose range is between 2–
10 mg/kg/dose/day of artesunate and 7–11 mg/kg/dose/day of mefloquine.

Mefloquine is associated with an increased incidence of nausea, vomiting, dizziness,
dysphoria and sleep disturbance in clinical trials, but these are seldom debilitating –
where this ACT has been deployed it has been well tolerated. To reduce acute vomiting
and optimize absorption, the 25 mg/kg dose is usually split and given either as 15 mg/kg
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