Page 269 - HPP ANTIMICROBIAL GUIDELINE 2018

Infection/Condition Suggested Treatment Comments
Preferred Alternative

Malaria

Plasmodium falciparum Artesunate /mefloquine available as FDC tablet: 25/55mg and 100/220mg

Artesunate /mefloquine may cause seizure in children with epilepsy

Lumefantrine absorption is enhanced by co-administration with fat containing food or milk

Primaquine 0.75mg base/kg to be given on Day 1 as a single dose in addition to ACT (check G6PD status before use).

Parenteral artesunate should be given for a minimum of 24h or until patient is able to tolerate orally and thereafter to
complete treatment with a complete course of oral ACT (ASMQ or Riamet).
-
Change to Quinine PO if able to tolerate orally. (Maximum quinine per dose = 600mg.) Reduce quinine IV dose by one third
of total dose if unable to change to quinine PO after 48hours or in renal failure or liver impairment

a)Uncomplicated Artesunate /mefloquine Riamet®
5 - 8kg, 6 -11 mths : 25/55mg PO q24h (1 tablet: Artemether/ lumefantrine
9 - 17kg, 1-6 yr : 50/110mg PO q24h 20/120mg)
18 - 29kg, 7-12 yr : 100/220mg PO q24h
≥30kg, >13 yr : 200/440mg PO q24h The patient should receive an initial dose,
nd
for 3 days followed by 2 dose 8 hours later, then
1 dose q12h for the following 2 days

5- <15kg : 1 tab per dose
15 - <25kg: 2 tab per dose
25 - <35kg: 3 tab per dose
≥35kg : 4 tab per dose
b) Treatment failure An alternative ACT regimen to be used.
( eg: If Riamet® is used as the first line regimen,
so the choice will be artesunate /mefloquine and
vice versa)

HPP AMG Tropical Infections 129