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.