Management of Severe Malaria in Paediatric In-patients

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TREATMENT

  • Give Artesunate 2.4 mg/kg body weight IV for adults of 20kg or more and 3.0mg/kg body weight for children of 20kg or less) on admission (at 0 hour)
    • Repeat at 12 hours and 24 hours, after initiating the first dose then once daily for not more than six days
    • Switch to LA once the patient can take oral treatment after at least 24 hours of Parenteral Artesunate
    • There should be an interval of at least 8 hours between the last dose of Artesunate and the first dose of LA

Alternatively

  • Give Artesunate 2.4 mg/kg or 3.0mg/kg body weight for children less than 20 kg IM into the upper-outer quarter of anterior thigh if intravenous bolus is not feasible

Note: Artesunate solution should be freshly prepared prior to administration and should never be stored

In case Artesunate is not available or is contraindicated, then

  • Give Parenteral Quinine
  • Refer to section on Malaria to determine the number of vials needed for treatment
  • For children, Quinine IV is administered as follows:
    • Initial (loading) dose 20 mg (Quinine Salt)/kg body weight: inject this dose into 10 ml/kg of 5% Dextrose or half strength Darrow's and infuse over 3-4 hours
    • If patient has already received Quinine for this illness, the first dose IV infusion should be 10 mg/kg diluted as above and given over 3-4 hours with no loading dose
    • Subsequent doses of 10 mg/kg should be given every 12 hours
    • The infusion should run for 3 - 4 hours. Continue the 5% Dextrose or half strength Darrow's IV fluid (10 ml/kg given over 3 - 4 hours) between doses of quinine
    • Switch to LA once the patient can take oral treatment after at least 24 hours of Parenteral Quinine

Note: LA should only be taken 12 hours after last dose of quinine to avoid cardiotoxicity