Uncomplicated Malaria (Chloroquine-Sensitive Strains)
- Chloroquine (10 mg base/kg stat, then 5 mg/kg at 6, 24, 24 hours)
- Rationale: Effective against P. vivax, P. malariae, P. ovale, and some P. falciparum strains.
- Alternative: Chloroquine phosphate (1 g at 0 hours, then 500 mg at 6, 24, 48 hours)
- Rationale: Same dosing as above, but in mg of salt form.
- Uncomplicated Malaria (Chloroquine-Resistant Strains)
- Artemisinin-based combination therapies (ACTs) (e.g., artemether-lumefantrine, artesunate-amodiaquine)
- Rationale: First-line treatment for P. falciparum in endemic areas due to high efficacy and reduced resistance risk.
- Atovaquone-proguanil (4 tablets/day for 3 days)
- Rationale: Alternative for P. falciparum with good efficacy but higher cost.
- Severe Malaria (P. falciparum)
- Intravenous artesunate (2.4 mg/kg at 0, 12, 24 hours, then daily)
- Rationale: Reduces mortality compared to quinine per WHO guidelines.
- Quinine (20 mg/kg loading dose, then 10 mg/kg every 8 hours for 7 days)
- Rationale: Alternative if artesunate unavailable, but higher risk of adverse effects.
- P. vivax Relapse Prevention
- Chloroquine (same as above) + Primaquine (0.15–0.4 mg base/kg/day for 14 days)
- Rationale: Primaquine targets hypnozoites to prevent relapse.
- Pregnancy Considerations
- First trimester: Quinine + clindamycin (7 days)
- Rationale: Avoids teratogenic risks of ACTs.
- Second/third trimester: ACTs (e.g., artemether-lumefantrine)
- Rationale: Safer profile with proven efficacy.
Key Guidelines:
- WHO 2020 Malaria Treatment Guidelines
- CDC 2022 Malaria Treatment Guidelines
- Rationale: Evidence-based recommendations for drug selection and dosing.