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7. Treatment of uncomplicated P. falciparum malaria
given below are that effective medicines should be used to treat travellers; if the patient
has taken chemoprophylaxis, then the same medicine should not be used for treatment.
The treatment for P. vivax, P. ovale and P. malariae in travellers should be the same as
for these infections in patients from endemic areas (see Section 9).
In the management of severe malaria outside endemic areas, there may be delays in
obtaining artesunate, artemether or quinine. If parenteral quinidine is available but
other parenteral drugs are not, then this should be given with careful clinical and
electrocardiographic monitoring (see Section 8).
box 7.8
recommendations: treatment for travellers returning to non-endemic countries with uncomplicated
falciparum
for travellers returning to non-endemic countries with uncomplicated malaria: a
• atovaquone plus proguanil (15/6 mg/kg [adult dose – 4 tablets] once a day for 3 days)
• artemether plus lumefantrine
• dihydroartemisinin plus piperaquine
• quinine plus doxycycline or clindamycin
b
for severe malaria:
• the antimalarial treatment in travellers is the same as shown in Section 8
• travellers with severe malaria should be managed in an intensive care unit
a. Halofantrine is not recommended as first-line treatment for uncomplicated malaria because of cardiotoxicity.
b. Doxycycline should not be used in children under 8 years of age.
box 7.9
Summary recommendations on the treatment of falciparum malaria in special Groups
pregnancy
First trimester:
a
– quinine plus clindamycin to be given for 7 days (artesunate plus clindamycin for 7 days is indicated if
this treatment fails);
– an ACT is indicated only if this is the only treatment immediately available, or if treatment with 7-day
quinine plus clindamycin fails or if there is uncertainty of compliance with a 7-day treatment.
Second and third trimesters:
– ACT known to be effective in the country/region or artesunate plus clindamycin to be given for 7 days
b
or quinine plus clindamycin to be given for 7 days.
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