Uncomplicated malaria

Children less than 5kg body weight should be given Co-artemether (Artemether-Lumefantrine) as the first line treatment for uncomplicated malaria. Children less than 2kg body weight should be treated as severe malaria cases.

Treatment Schedule for co-artemether children less than 5kg body weight:

**Remember treat children <2kg as severe malaria

Treatment failure, should be suspected clinically if there is no response after 48 hours of correct therapy, and a change to second line therapy made immediately.

Early treatment failure is formally diagnosed if a patient is still febrile 72hrs after initial therapy and has more than 25% of initial asexual parasitaemia.

Late treatment failure is the recurrence of fever and asexual parasitaemia 7- 14 days after initial successful treatment.

Treatment failure may be due to:

• Inadequate therapy, e.g. medicine being vomited within 1/2 hour, under dosing or failure to complete the treatment
• Presence of undetected severe and complicated malaria
• Malaria parasite resistance (known or suspected) to the given medicine.

If a patient returns to the health facility still feeling unwell:

• Check for other conditions e.g. meningitis, ARI, gastro-enteritis
• Check for signs of severe and complicated malaria
• Take a blood slide

If there are no signs of severe/complicated malaria give the following treatment immediately:

Second Line Therapy Artesunate/amodiaquine po - Dose - as per table below; once daily for 3 days

Each tablet of AS-AQ may contain Artesunate 25mg and Amodiaquine 67.5mg OR Artesunate 50mg and Amodiaquine 135mg OR Artesunate 100mg and Amodiaquine 270mg

Dosage is 4mg/kg body weight Artesunate and 10mg/kg Amodiaquine base taken once daily orally for three days.

Second line treatment of uncomplicated malaria in adults unable to tolerate artesunate-amodiaquine is oral quinine with doxycycline or clindamycin 

Each Quinine tablet contains quinine sulphate 300mg

Treatment schedule for second line therapy: Adults

N.B:-

1. *Doxycycline is contraindicated in children below 8 years and in pregnancy and these patients should complete the 7 day quinine
2. Clindamycin is used in place of Doxycycline in pregnancy during the first trimester and children under the age of eight years. (see Uncomplicated Malaria in Pregnancy above)
3. If for any reason Quinine is given as monotherapy (without Doxycycline or Clindamycin), it should be given for a total of seven days.

In malaria elimination areas the appropriate treatment of uncomplicated malaria is   

*Gametocyte clearance

WHO recommends a low dose primaquine to minimise the chances of clinically significant haemolysis where G6PD assay has not been done. The following patients should be given Primaquine 0.25 mg base/kg body weight with first dose of ACT for uncomplicated malaria:

• Above one year old
• Bodyweight above 10kg
• Not pregnant

Primaquine comes as 26.3 mg Primaquine phosphate equivalent to 15 mg Primaquine base or 13.2 mg Primaquine phosphate equivalent to 7.5 mg Primaquine base tablets. 

Dilution instruction for primaquine 15mg tablet:

• Mix 15 ml water with one crushed tablet of 15 mg Primaquine base, making a suspension of 1 mg/ml.

NOTE: DO NOT GIVE PRIMAQUINE TO THE FOLLOWING;

• Patients with severe malaria (see Severe Malaria for definition)
• Pregnant and breastfeeding patients
• Known history of G6PD deficiency
• Pallor or existing anaemia, haemoglobin < 8gm/dl
• Patients on medications likely to cause haemolysis
• Patients on medicines likely to cause bone marrow suppression
• Patients taking Zidovudine or any medicines containing Zidovudine