1 If a person develops malaria despite taking chemoprophylaxis, that particular medicine should not be used as a part of their treatment

regimen. Use one of the other options instead.

2 NOTE: There are 4 options (A, B, C, or D) available for treatment of uncomplicated malaria caused by chloroquine-resistant P. falciparum. Options A, B, and C are equally recommended. Because of a higher rate of severe
neuropsychiatric reactions seen at treatment doses, we do not recommend option D (mefloquine) unless the other options cannot be used. For option C, because there is more data on the efficacy of quinine in combination with doxycycline
Clinical
Severe
Uncomplicated
14 Diagnosis/
malaria
or tetracycline, 14,treatment
these
malaria/ falciparum Region
15, 16 P. combinations are generally
or Infection
All regions toAcquired
Chloroquine-sensitive
preferred quinine in combination Recommended
(Central America
with clindamycin. Drug
west of Quinidine and
Chloroquine gluconate
phosphate Recommended
14 plus one of theand Drug Quinidine
(Aralen andChloroquine
gluconatephosphate
14 plus one(Aralen
of the and
3 Takenot
with with food or whole milk. If patient vomits within Panama Canal; Haiti;
30 minutes thea Dominican
of taking dose, then they should repeatfollowing:
Republic; the dose. Doxycycline,
generics)8 600 mg base Tetracycline,
(=1,000 mg or po
salt) following: Doxycycline
generics) 4, Tetracycline
8 10 mg base/kg 4, or
po immediately,
Plasmodium
Species species
identified
4 US manufactured quinine sulfate capsule is in a 324mgand dosage;
Adult Dose 1 Pediatric Dose1 Pediatric dose
mosttherefore 2 capsules
of the Middle should be sufficient for adult
East) dosing.
Clindamycin Pediatricfollowed
immediately, dosing may
Quinidine by be difficult
gluconate:
300 mg basedue6.25to unavailability
(=500 of non-capsule
mgClindamycin
followed forms
by 5 Quinidine
mg of quinine.
base/kg gluconate:
po at 6, 24,Same
and 48
5 For infections acquired in Southeast Asia, quinine treatment should continue for 7 days. For infections acquired mg elsewhere,
base/kg quinine
(=10
should
treatment should NEVER
continue exceed
for days.adult
IV3 1,500
dose
salt) po at 6, 24,mg salt/kg)
and 48 hours loading
Totaldose
dose: mg/kg dosing
hours anddose:
Total recommendations
25 mg base/kg as forOR
Uncomplicated
6 Doxycycline and malaria/
tetracycline P. Chloroquine-resistant
are not indicated or unknown
for use in children less than 8 years old. For A. Atovaquone-proguanil
children less than 8 years A. Atovaquone-proguanil
overmgold
1-2 with
basehrs, chloroquine-resistant
(=2,500
then 0.0125
mg salt) P. falciparum, atovaquone-proguanil
mg base/kg/min
OR adults. and artemether-lumefantrine
Hydroxychloroquine
Doxycycline: Treatment
(Plaquenil asTMare recommended
above.
and If
treatment options; mefloquine can be considered resistance 2 (All
if no other malarious
options regionsFor children
are available. (Malarone)
less than 8 years
3 oldAdult tab = 250
with chloroquine-resistant (Malarone)
P. vivax, mefloquine
3 isAdult tab =
the recommended treatment. If it is not available or is not being
falciparum or Species not identified (=0.02 mg salt/kg/min)
Hydroxychloroquine continuous
(Plaquenil infusion
TM and for patient not able
generics) 10to take
mg oral
base/kg medication,
po may
immediately,
tolerated and if the treatment benefits outweigh the risks,
except thoseatovaquone-proguanil or artemether-lumefantrine
specified as chloroquine- mg atovaquone/ should
100be mg
usedproguanil
instead. 250 mg atovaquone/ 100 mg
If 7species
Treatmentnotwithidentified
mefloquine isis not recommended in persons at generics)
least
drug24resistance.
hours.
620 mg Anbase
alternative
(=800 mg regimen
salt) pois 15 givefollowed
IV. For children
by 5 mg <45base/kgkg, give
po at2.2
6, 24,
mg/kg
and 48
sensitive listedwho havebox
in the acquired infections from
below.) Southeast
4 adult tabs poAsia
qddue
x 3todays proguanil Peds tab = 62.5 mg
subsequently
8When treating diagnosed as P. vivax
chloroquine-sensitive infections, chloroquine and hydroxychloroquine are recommended options. mg base/kg
immediately,
However, (=24followed
regimens mg salt/kg)
used to by 310
treat loading dose(=400
mg base IV mg
chloroquine-resistant
atovaquone/ 25 mg proguanil
IV every
hours
infections may
5-
12also
hours
Totalbe and ifthen
dose:
used 25 switch
mg to oral
base/kg
available, more convenient, or
orpreferred.
P ovale: see P. vivax and P ovale infused
salt) poover
at 6,
4 hours,
24, andfollowed
48 hoursbyTotal 7.5 mg dose: 1,550doxycycline (dose as above) as soon as patient
8kg: 2 peds tabs po qd x 3 can d cause9-hemolytic anemia in G6PD-deficient persons, G6PD
9Primaquine is used to eradicate any hypnozoites that may remain dormant in the liver, and thus prevent relapses, base/kg in mg (=12
base
P. vivax mg
(=2,000
and salt/kg)
P. ovale mg infused
salt)
infections. over 4primaquine
Because hours can take oral medication. For children >45 kg,
(below) re. treatment with 10kg: 3 peds tabs po may qd xbe 3 dgiven 45 mg orally one time per week for 8 weeks; consultation
screening must occur prior to starting
Uncomplicated malaria/ P. malariae or P. treatment with primaquine.
All regionsFor persons with borderline G6PD deficiency or as
everyan alternate
Chloroquine to the
8 hours, starting above
phosphate: regimen,
8 hours primaquine
8 Treatment
after the loading
as above use same Chloroquine
dosing asphosphate:
for adults. 8ForTreatment
IV use, as above
primaquine
with an expert in infectious disease and/or tropical medicine is advised if this alternative regimen is considered in dose G6PD-deficient persons. 11-20kg: 1adult
Primaquine must nottabbepousedqd x 3 d pregnancy.
21-
knowlesi OR(see package insert).
Hydroxychloroquine: Once parasite
Treatment as above during
density avoidORrapid administration. Treatment
Hydroxychloroquine: course
Treatment as =
above
30kg: 2 adult tabs po qd x 3d 31-
Uncomplicated malaria/ P. vivax or P. ovale All regions Note: for suspected chloroquine- <1%
Chloroquine
and patientphosphate
can take oral
8 plus
medication,
Primaquine 7 days.
Chloroquine
Tetracycline:
phosphate
Treatment
8 plus Primaquine
as above
40kg: 3 adult tabs po qd x 3d > 40
10 NOTE: There are three options (A, B, or C) available resistant P. vivax,
for treatment see row below
of uncomplicated complete
phosphate
malaria caused by chloroquine-resistanttreatment with oral
Chloroquine
9P. vivax. High quinine, doserates
phosphate:
treatment failure as due toClindamycin:
phosphate9Treatment
chloroquine-resistant Chloroquine
P. vivaxashave
above.
beenIfwell
patient
phosphate: documented in
Papua New Guinea and Indonesia. Rare case reports of chloroquine-resistant P. vivax have also been documentedabove. inTreatment
Burma (Myanmar), kg:and
4 adult tabs poSouth
qd xAmerica.
3d
as aboveIndia,Primaquine
Quinidine/quinine Central
course = 7 and
days
phosphate:
in Persons
not able
Treatment acquiring
to take asoral P. vivax
above infections
medication,
Primaquine: outside
give 10 mg of Papua New
0.5mg
B.Guinea
Artemether-lumefantrine (Coartem)
or Indonesia should be started 3
on chloroquine.1 tablet = 20mg
If the patient doesartemether
not respond,and 120 mg should
the treatment lumefantrine
be changed Aa3-day
to treatment schedule
chloroquine-resistant with
P. vivax a total of 6 oral dosesbe notified (Malaria Hotline number listed above). For
Southeast
30 mg Asia;po=qd
base 3 days
x 14 in Africa
days ORorregimen
South and CDCbase/kg
should loading
base/kg po qd dose IVdays
x 14 followed by OR 5 mg
is treatment
recommended for both adult and
of chloroquine-resistant pediatric
P. vivax patients
infections, based
options on andweight.
A, B, The patient
C are equally should receive the initial dose, followed by the second dose 8 hours later, then 1
recommended. America.
Hydroxychloroquine
Doxycycline:plus Treatment
Primaquine as above. base/kg
Hydroxychloroquine
IV every 8 hours. Switch plus Primaquine
to oral
dose popregnant
11 For bid for the
womenfollowing
diagnosed 2with
days. 5 - <15malaria
uncomplicated kg: 1caused
tabletbyper dose 15 - <25 kg:
chloroquine-resistant 2 tablets per
P. falciparum dose 25 - <35 kg:
or chloroquine-resistant 3 tablets
P. vivax per dose
infection, treatment35 kg:doxycycline
with 4 tablets
or tetracycline is generally not indicated. However,
If phosphate
patient not 9able Hydroxychloroquine:
to take oral medication,Treatment
give clindamycin
phosphate (oral dose as above) as soon Treatment
9 Hydroxychloroquine: as as
perdoxycycline
dose or tetracycline may be used in combination with quinine (as recommended for non-pregnant adults) if other treatment options are not available or are not being tolerated, and the benefit is judged to outweigh the risks.
100as mg
above
IV everyPrimaquine
12 hours and
phosphate:
then switch 30 tomg basepatient
abovecan take
Primaquine
oral medication.
phosphate:
12 Atovaquone-proguanil and artemether-lumefantrine are generally not recommended for use in pregnant women, particularly in the first trimester due to lack of sufficient safety data. For pregnant women diagnosed with uncomplicated
For 0.5mg
IV use,base/kg
C.malaria
Quinine sulfate
caused plus one of the following:
by chloroquine-resistant Doxycycline,
P. falciparum C. Quinine sulfateoral
Tetracycline, or or artemether-lumefantrine
infection, atovaquone-proguanil podoxycycline
plus
4may qdone
be x 14ofifdays
used the (as
other above) as
following:
treatment soonareas not
Doxycycline
options patient avoid
arepo
6, Tetracycline
available or rapid
notqd x administration.
6 being days and if Treatment
14tolerated, the potentialcourse
benefit=is judged to
Clindamycin Quinine
outweigh the potential
Uncomplicated malaria/ sulfate:
risks. P. vivax542 mg base (=650 Chloroquine-resistant
mg salt)4 po tid x103 (Papua
or orNew Guinea
Clindamycin canA.take
Quinine
Quinine oral medication.
sulfate
sulfate: plusbase/kg
8.3 mg For
either
IV use,
Doxycycline
(=10avoid
mg salt/kg)or po
7 days.
A. tid
Quinine
Investigational
sulfate plus
new drug
either(contact
Doxycycline6 or
13 For5 P. vivax
7 days and P. ovale100
Doxycycline: infections,
mg poprimaquine
bid x 7 daysphosphate for radical treatment
Tetracycline:
and Indonesia) 250 mg of pohypnozoites
x 3 orshould rapid
not5 be given
7 days administration.
Tetracycline
during
Doxycycline: plus
pregnancy.
2.2 Treatment
Primaquine
Pregnant
mg/kg course
patients
po every 12with= 7P. vivax
phosphate
hours andCDC
x 97 days forinfections
P. ovale information):
Tetracycline 6should Artesunate
be maintainedfollowed
plus Primaquine phosphate
on chloroquine
9

qidprophylaxis
x 7 days for Clindamycin:
the duration of their pregnancy.
20 mg The chemoprophylactic
base/kg/day po divided tid x dose of chloroquineTetracycline:
7 days phosphate is 30025 mgmg/kg/day
base
days. (=500
Quinine mg salt) orally
Tetracycline:
sulfate:
po divided once
x 7 per
Treatment
Treatment
qid asweek.
days as
above After delivery,by
above
Clindamycin: pregnant
mg ofpatients
20one
Quinine who doTreatment
thesulfate:
following: not have G6PD
Atovaquone- deficiency should be
as above
treated with primaquine. Clindamycin:
Doxycycline or Treatment as above.
Tetracycline: If patient
Treatment as proguanil (Malarone),
Doxycycline Clindamycin,
or Tetracycline: or as
Treatment
base/kg/day po divided tid x 7 days
D. Mefloquine (Lariam and generics)7 684 mg base (=750 mg salt) po as D. Mefloquine (Lariamnotabove
able toandtake
Primaquine
oral medication,
generics) phosphate:
7 13.7 mggive 10
base/kgTreatment
mg
(=15 mgassalt/kg)
Mefloquine
above
po Primaquine phosphate: Treatment as
14 Persons
initial dose,with a positive
followed bloodmg
by 456 smear
baseOR history
(=500 mgofsalt)
recentpopossible exposure
given 6-12 andafter
hours no other recognized pathology
as initial dose, base/kg
who
followed byloading
have
above one mg
9.1 dose
or more ofIV
base/kg followed
the(=10
following by 5 mgpo
clinical
mg salt/kg) criteria
given 6-12above
(impaired consciousness/coma, severe normocytic anemia, renal
failure, pulmonary edema, acutemg
respiratory distress syndrome, circulatory shock, disseminated intravascular
B.initial dose Total dose=
Atovaquone-proguanil 1,250 salt
plus Primaquine phosphate9 Atovaquone-proguanil:hours ascoagulation,
after initial
Treatment base/kg
dose. spontaneous
IV dose=
Total every 825bleeding,
hours. acidosis,
Switch
mg salt/kg
B. Atovaquone-proguanil 89 to
plus hemoglobinuria,
oral
Primaquine jaundice, repeated generalized convulsions, and/or parasitemia of >
phosphate 9 Atovaquone-proguanil: Treatment as
5%) are considered to have manifestations of more severe disease. Severe malaria is most often caused by P. falciparum. clindamycin (oral dose as phosphate:
above) as soon as
above Primaquine phosphate: Treatment as above above Primaquine Treatment as above
15Patients diagnosed with severe malaria should be treated aggressively with parenteral antimalarial therapy. Treatment with IV quinidine should be initiated as soon as possible after the diagnosis has been made. Patients with severe
C. Mefloquine patient can take oral medication. For IV use,
malaria shouldplus Primaquine
be given phosphate9
an intravenous loading dose ofMefloquine: Treatment
quinidine unless they haveasreceived
above morePrimaquine C. Mefloquine
than 40 mg/kg of quinine plus
in the preceding Primaquine
48 hours or if phosphate9
they have receivedMefloquine: Treatment
mefloquine within as above
the preceding 12 hours.Primaquine
Consultation with a
phosphate: avoid rapid administration. Treatment course =
cardiologistTreatment as above
and a physician with experience treating malaria is advised when treating malaria patients with quinidine. phosphate: Treatmentofasquinidine,
During administration above blood pressure monitoring (for hypotension) and cardiac monitoring (for widening
Uncomplicated malaria:
of the QRS complex and/oralternatives forthe QTc interval)
lengthening of Chloroquine-sensitive (see uncomplicated
should be monitored continuously 7 days.
and blood glucose (for Investigational
Chloroquine
hypoglycemia) new
phosphate: drug (contact
Treatment
should be monitored as above CardiacNot
periodically. applicable if severe, may warrant temporary
complications,
discontinuation
pregnant womenof 11,12,13 infusion.sections above for chloroquine-sensitive CDC
the drug or slowing of the intravenousmalaria ORfor information): Artesunate
Hydroxychloroquine: followed
Treatment as above
16 Pregnant women diagnosed with severe malaria should be treated aggressively with parenteral antimalarial therapy. by one of the following: Atovaquone-
species by region)
proguanil (Malarone), Doxycycline
Chloroquine-resistant (see sections above for regions with Quinine sulfate plus Clindamycin Quinine sulfate: Treatment Not applicable
(Clindamycin in pregnant women), or
chloroquine resistant P. falciparum and P. vivax) as above Clindamycin: Treatment as above
Mefloquine
OR Mefloquine: Treatment as above