Page 46 - 80 guidelines for the treatment of malaria_opt

nd
Guidelines for the treatment of malaria – 2 edition

 lactating women
– Lactating women should receive standard antimalarial treatment (including ACTs) except for dapsone,
primaquine and tetracyclines, which should be withheld during lactation.

 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.
– Referral to a health centre or hospital is indicated for young children who cannot swallow antimalarial
medicines reliably. If referral is expected to take more than 6 hours, pre-referral treatment with rectal
artesunate is indicated.

 travellers returning to non-endemic countries
Uncomplicated falciparum malaria:
– atovaquone plus proguanil,
– artemether plus lumefantrine,
– dihydroartemisinin plus piperaquine,
c
– quinine plus doxycycline or clindamycin; all drugs to be given for 7 days.
Severe malaria:
– the antimalarial treatment is the same as shown in Section 8.

a. If clindamycin is unavailable or unaffordable, then the monotherapy should be given.
b. With the exception of DHA+PPQ for which there is insufficient information in second and third trimesters of pregnancy to
use as first-line therapy.
c. Doxycycline should not be used in children under 8 years of age.

7.10 co-existing morbidities

7.10.1 HIV infection
There is considerable geographic overlap between malaria and HIV, resulting in substantial
numbers of individuals with co-infection. Worsening HIV-related immunosuppression
may lead to more severe manifestations of malaria. In HIV-infected pregnant women,
the adverse effects of placental malaria on birth weight are increased. In stable endemic
areas, HIV-infected patients with partial immunity to malaria may suffer more frequent
and higher density infections; while in areas of unstable transmission, HIV infection is
associated with an increased risk of severe malaria and malaria-related deaths. There is
limited information at present on how HIV infection modifies the therapeutic responses to
ACTs or on interactions between antimalarial medicines and antiretrovirals. Early studies
with less effective regimens suggested that increasing HIV-related immunosuppression
was associated with decreased treatment response, increased parasite burdens and
reduced host immunity. Both of these are now known to occur with HIV infection
32