Page 273 - HPP ANTIMICROBIAL GUIDELINE 2018

Infection/Condition Suggested Treatment Comments
Preferred Alternative

Plasmodium vivax Total Chloroquine 25mg base/kg divided over 3 Check G6PD status
New infection days, as below: before giving
Primaquine.
D1: 10mg base/kg PO stat G6PD deficiency:
then 5mg base/kg 6 hours later Primaquine 0.75mg
D2: 5mg base/kg PO q24h base/kg q7d for 8
D3: 5mg base/kg PO q24h weeks
PLUS
Primaquine 0.5mg base/kg PO q24h for 14 days If severe P.vivax,
treatment is as
Chloroquine resistant or Riamet® complicated
relapse (dosing as per P.falciparum treatment) Quinine 10mg salt/kg PO q8h for 7 days P.falciparum

PLUS PLUS
Primaquine 0.5mg/kg PO q24h for 14 days Primaquine 0.5mg/kg PO q24h for 14 days

Plasmodium malariae/ Chloroquine PO If severe P.vivax,
knowlesi (dosing as per P. vivax) treatment is as
complicated
P.falciparum

Mixed Infection Treat as P.falciparum

References:
1. Panaphut T. Ceftriaxone compared with sodium penicillin G for treatment of severe leptospirosis. Clin Infect Dis 2003; 36:1507-13
2. Suputtamongkol Y. An Open, Randomized, Controlled Trial of Penicillin, Doxycycline, and Cefotaxime for Patients with Severe Leptospirosis. Clin Infect
Dis 2004; 39:1417-24
3. White NJ. Melioidosis. Lancet 2003; 361:1715-22
4. Silpapojakul K. Paediatric scub typhus in Thailand: a study of 73 confirmed cases. Trans R Soc Trop Med & Hygiene 2004;98:354-9
5. Guidelines for the Diagnosis, Management, Prevention and Control of Leptospirosis in Malaysia, MOH 2011.
6. Cheng AC, Chierakul W, Chaowagul W, et al. Consensus guidelines for dosing of amoxicillin-clavulanate in melioidosis. Consensus guidelines for dosing
of amoxicillin-clavulanate in melioidosis. Am J Trop Med Hyg. 2008;78(2):208
7. Phimda K et al. Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus. Antimicrob Agents Chemother. 2007;51(9):3259

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