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7. Treatment of uncomplicated P. falciparum malaria

(usually on the second day) followed by 10 mg/kg one day later, or as a daily dose of
8.3 mg/kg for 3 days. (see Annex 3, Sections A3.5, A3.6.3,)

7.5.4 Artesunate plus sulfadoxine-pyrimethamine

This is currently available as separate scored tablets containing 50 mg of artesunate and
9
tablets containing 500 mg of sulfadoxine and 25 mg of pyrimethamine.
Therapeutic dose. A target dose of 4 mg/kg/day artesunate given once a day for 3 days
and a single administration of 25/1.25 mg/kg sulfadoxine-pyrimethamine on day 1, with
a therapeutic dose range between 2–10 mg/kg/day artesunate and 25–70/1.25–3.5 mg/kg
sulfadoxine-pyrimethamine.
This combination was sufficiently efficacious only where 28-day cure rates with sulfadoxine-
pyrimethamine alone exceeded 80%. Resistance is likely to worsen with continued
widespread use of sulfadoxine-pyrimethamine, sulfalene plus pyrimethamine and
cotrimoxazole (trimethoprim plus sulfamethoxazole) (see Annex 3, sections A3.3–A3.4,
A3.6.3).

7.5.5 Dihydroartemisinin plus piperaquine

This is currently available as a fixed-dose combination with tablets containing 40 mg of
dihydroartemisinin and 320 mg of piperaquine.
Therapeutic dose. A target dose of 4 mg/kg/day dihydroartemisinin and 18 mg/kg/day
piperaquine once a day for 3 days, with a therapeutic dose range between 2–10 mg/kg/day
dihydroartemisinin and 16–26 mg/kg/dose piperaquine (see Annex 3, Section A3.6.4).

7.5.6 Artesunate plus tetracycline or doxycycline or clindamycin
There are no blister co-packaged forms of any of these combination options. These are
reserved for very rare occasions of treatment failures to the recommended ACTs and
in some special groups, e.g. pregnant women failing ACT treatment. They are dosed
separately and should only be used in a hospital setting.

Therapeutic dose. Artesunate (2 mg/kg once a day) plus tetracycline (4 mg/kg four times
a day or doxycycline (3.5 mg/kg once a day) or clindamycin (10 mg/kg twice a day). Any
of these combinations should be given for 7 days.

7.6 incorrect approaches to treatment

Artemisinins should not be used as monotherapy, as this will promote resistance to this
critically important class of antimalarials. Wherever possible, artemisinins should be used

9 A similar medicine with tablets containing 500 mg of sulfalene and 25 mg of pyrimethamine is considered to be
equivalent to SP.
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