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Artemisinin combination therapy (ACT) regimens for treatment of uncomplicated non-falciparum malaria in nonpregnant adults and children*

Artemisinin combination therapy (ACT) regimens for treatment of uncomplicated non-falciparum malaria in nonpregnant adults and children*
  Formulations available Body weight (kg) Dose*
Artemether-lumefantrineΔ

Available as tablets containing
20 + 120 mg or
40 + 240 mg
of artemether and lumefantrine, respectively

An orally disintegrating flavored tablet is available in some areas

  Dose administered orally twice daily for three days:
5 to <15 20 + 120 mg
15 to <25 40 + 240 mg
25 to <35 60 + 360 mg
≥35 80 + 480 mg
Dihydroartemisinin-piperaquine Available as tablets containing
20 + 160 mg or
40 + 320 mg
of dihydroartemisinin and piperaquine, respectively
  Dose administered orally once daily for three days:
5 to <8 20 + 160 mg
8 to <11 30 + 240 mg
11 to <17 40 + 320 mg
17 to <25 60 + 480 mg
25 to <36 80 + 640 mg
36 to <60 120 + 960 mg
60 to <80 160 + 1280 mg
≥80 200 + 1600 mg
Artesunate-mefloquine Available as tablets containing
25 + 55 mg or
100 + 220 mg
of artesunate and mefloquine hydrochloride, respectively§
  Dose administered orally once daily for three days:
5 to <9 25 + 55 mg
9 to <18 50 + 110 mg
18 to <30 100 + 220 mg
≥30 200 + 440 mg
Artesunate-amodiaquine Available as tablets containing
25 + 67.5 mg,
50 + 135 mg, or
100 + 270 mg
of artesunate and amodiaquine, respectively
  Dose administered orally once daily for three days:
4.5 to <9 25 + 67.5 mg
9 to <18 50 + 135 mg
18 to <36 100 + 270 mg
≥36 200 + 540 mg
The dosing regimens listed in this table are consistent with the World Health Organization 2022 guidelines for the treatment of malaria and may differ from dosing recommended in approved product information. Product availability varies by locality.

DP: dihydroartemisinin-piperaquine.

* In general, the course of ACT is administered for three days. In areas of artemisinin resistance, a six-day course of treatment is warranted.

¶ 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 glucose-6-phosphate dehydrogenase (G6PD) status has been confirmed; options for antirelapse therapy include primaquine or tafenoquine. Refer to UpToDate topics for further discussion.

Δ Take after a full meal or whole milk. If patient vomits within 30 minutes of taking a dose, then they should repeat the dose. Ideally, the first two doses should be taken 8 hours apart.

◊ Piperaquine prolongs the QT interval by approximately the same amount as chloroquine but by less than quinine. DP should not be used in patients with congenital QT prolongation or who are on medications that prolong the QT interval. DP may be taken with food but should not be taken with a high-fat meal.

§ Mefloquine hydrochloride (55 mg) is equivalent to mefloquine base (50 mg); mefloquine hydrochloride (220 mg) is equivalent to mefloquine base (200 mg).
Data from: World Health Organization. Guidelines for malaria. Geneva 2022.
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