Drug | Adult dose | Pediatric dose (not to exceed adult dose) |
Preferred regimens¶ | ||
Artemisinin combination therapy | Regimens and doses summarized in separate table | Regimens and doses summarized in separate table |
ChloroquineΔ | Dose 1: 1000 mg salt (= 600 mg base) orally Doses 2 to 4 (3 additional doses) at 6, 24, and 48 hours: 500 mg salt (= 300 mg base) orally per dose (Total dose: 2500 mg salt [= 1500 mg base]) | Dose 1: 16.7 mg salt/kg (10 mg base/kg) orally Doses 2 to 4 (3 additional doses) at 6, 24, and 48 hours: 8.3 mg salt/kg (5 mg base/kg) orally per dose (Total dose: 41.6 mg salt/kg [25 mg base/kg]; maximum total dose: 2500 mg salt [= 1500 mg base]) |
Alternative regimens | ||
HydroxychloroquineΔ◊ | Dose 1: 800 mg salt (= 620 mg base) orally Doses 2 to 4 (3 additional doses) at 6, 24, and 48 hours: 400 mg salt (= 310 mg base) orally per dose (Total dose: 2000 mg salt [= 1550 mg base]) | Dose 1: 12.9 mg salt/kg (10 mg base/kg) orally Doses 2 to 4 (3 additional doses) at 6, 24, and 48 hours: 6.5 mg salt/kg (= 5 mg base/kg) orally per dose (Total dose: 32.4 mg salt/kg [25 mg base/kg]; maximum total dose 2000 mg salt [= 1550 mg base]) |
Atovaquone-proguanil§ Adult tab = 250 mg atovaquone/100 mg proguanil Pediatric tab = 62.5 mg atovaquone/25 mg proguanil | 4 adult tabs orally once daily for 3 days | 5 to <8 kg: 2 pediatric tabs orally once daily for 3 days 8 to <10 kg: 3 pediatric tabs orally once daily for 3 days 10 to <20 kg: 1 adult tab orally once daily for 3 days 20 to <30 kg: 2 adult tabs orally once daily for 3 days 30 to <40 kg: 3 adult tabs orally once daily for 3 days ≥40 kg: 4 adult tabs orally once daily for 3 days |
Quinine sulfate¥ Plus one of the following: | United States: Quinine sulfate 648 mg salt¥ (= 538 mg base) orally 3 times daily for 3 or 7 days† Canada, European Union, United Kingdom: Quinine sulfate 600 mg salt¥ (= 500 mg base) orally 3 times daily for 3 or 7 days† | Quinine sulfate:¥ 10 mg salt/kg (= 8.3 mg base/kg) orally 3 times daily for 3 or 7 days† |
Plus one of the following: | Plus one of the following: | |
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Mefloquine** | 500 mg salt (= 456 mg base) orally once daily for 3 days or 8 mg salt/kg (= 7.3 mg base/kg) orally once daily for 3 days, whichever is less. (Total maximum dose: 1500 mg salt [= 1369 mg base] in equally divided doses over 3 days) | 8 mg salt/kg (= 7.3 mg base/kg) orally once daily for 3 days; maximum 500 mg salt (= 456 mg base) per dose (Total dose: 24 mg salt/kg (= 22 mg base/kg); maximum 1500 mg salt [= 1369 mg base] in equally divided doses over 3 days) |
CDC: United States Centers for Disease Control and Prevention; G6PD: glucose-6-phosphate dehydrogenase; ACT: artemisinin combination therapy; WHO: World Health Organization.
* For treatment of infection due to Plasmodium vivax and Plasmodium ovale, presumptive antirelapse therapy to eradicate the hypnozoite liver stages should be administered after fever has subsided and normal G6PD status has been confirmed; options for antirelapse therapy include primaquine or tafenoquine. Refer to the UpToDate topics for further discussion.
¶ The approach to antimalarial selection depends on a number of factors including species diagnosis and likelihood of chloroquine resistance. Preferred regimens for treatment of chloroquine-sensitive non-falciparum malaria consist of chloroquine or ACT. Preferred regimens for treatment of chloroquine-resistant non-falciparum malaria consist of ACT. If an antimalarial is taken for chemoprophylaxis, a different drug should be used for treatment.
Δ In the United States and Canada, pill strengths for chloroquine and hydroxychloroquine are labeled in salt; in many other countries, pill strengths are labeled in base. 250 mg chloroquine phosphate (salt) is equivalent to 150 mg chloroquine base; 200 mg hydroxychloroquine sulfate (salt) is equivalent to 155 mg hydroxychloroquine base.
◊ Hydroxychloroquine is appropriate only for treatment of chloroquine-susceptible infection.
§ Take with food or whole milk. If the patient vomits within 30 minutes of taking a dose, then they should repeat the dose. It is also acceptable to take one-half of the dose twice daily.
¥ In the United States and Canada, pill strengths for quinine are labeled as quinine sulfate (salt); in many other countries, pill strengths are labeled in quinine base. 324 mg quinine sulfate (salt) = 269 mg quinine base. Pediatric dosing may require compounding pharmacy, since noncapsule forms of quinine are not available in the United States.
‡ Tetracycline antibiotics may cause permanent tooth discoloration for children <8 years if used repeatedly. However, doxycycline binds less readily to calcium than other tetracyclines and may be used for ≤21 days in children of all ages.[1]
† For infections acquired in Southeast Asia, quinine treatment should continue for 7 days. For infections acquired elsewhere, quinine treatment should continue for 3 days.
** Mefloquine should be used only if other options are not available, and it is not recommended for children <15 kg or in patients with neuropsychiatric history. The dosing regimen for mefloquine outlined above is in alignment with the WHO[2], which differs from the CDC approach; the WHO approach is associated with greater bioavailability and is better tolerated[3]. In the United States and Canada, pill strengths for mefloquine are labeled in hydrochloride salt; in many other countries, pill strengths are labeled in mefloquine base. 250 mg mefloquine hydrochloride (salt) is equivalent to 228 mg mefloquine base.Adapted from: United States Centers for Disease Control and Prevention. Guidelines for Treatment of Malaria in the United States: https://www.cdc.gov/malaria/resources/pdf/Malaria_Treatment_Table.pdf (Accessed on September 15, 2022) CDC Malaria Hotline: (770) 488-7788 Monday to Friday 8:00 am to 4:30 pm EST; (770) 488-7100 after hours, weekends, and holiday.