Disease severity | Adult dosing | Pediatric dosing |
Mild to moderate disease (ambulatory patients)*¶Δ |
Preferred regimen | Azithromycin - 500 mg orally once on day 1, followed by
- 250 mg orally once daily beginning on day 2
| Azithromycin - 10 mg/kg orally once on day 1 (maximum 500 mg/dose), followed by
- 5 mg/kg orally once daily beginning on day 2 (maximum 250 mg/dose)
|
PLUS | PLUS |
Atovaquone◊ - 750 mg orally every 12 hours
| Atovaquone◊ - 20 mg/kg orally every 12 hours (maximum 750 mg/dose)
|
Alternative regimen§ | Clindamycin - 600 mg orally every 8 hours
| Clindamycin - 7 to 10 mg/kg orally every 6 to 8 hours (maximum 600 mg/dose)
|
PLUS | PLUS |
Quinine sulfate¥ - 650 mg orally every 8 hours
| Quinine sulfate¥ - 8 mg/kg orally every 8 hours (maximum 650 mg/dose)
|
Severe acute disease (hospitalized patients): Initial management‡ |
Preferred regimen | Azithromycin† - 500 mg IV once daily until symptoms abate, then transition to all-oral regimen (refer to 'Step-down therapy' below)
| Azithromycin** - 10 mg/kg IV once daily (maximum 500 mg/dose) until symptoms abate, then transition to all-oral regimen (refer to 'Step-down therapy' below)
|
PLUS | PLUS |
Atovaquone◊ - 750 mg orally every 12 hours
| Atovaquone◊ - 20 mg/kg orally every 12 hours (maximum 750 mg/dose)
|
Alternative regimen§ | Clindamycin - 600 mg IV every 6 hours until symptoms abate, then transition to all-oral regimen (refer to 'Step-down therapy' below)
| Clindamycin - 7 to 10 mg/kg IV every 6 to 8 hours (maximum 600 mg/dose) until symptoms abate, then transition to all-oral regimen (refer to 'Step-down therapy' below)
|
PLUS | PLUS |
Quinine sulfate¥ - 650 mg orally every 8 hours
| Quinine sulfate¥ - 8 mg/kg orally every 8 hours (maximum 650 mg/dose)
|
Severe acute disease (hospitalized patients): Step-down therapy (eg, once symptoms have improved and parasitemia has declined)¶¶ |
Preferred regimen | Azithromycin - 250 to 500 mg orally once daily
| Azithromycin - 5 to 10 mg/kg orally once daily (maximum 500 mg/dose)
|
PLUS | PLUS |
Atovaquone◊ - 750 mg orally every 12 hours
| Atovaquone◊ - 20 mg/kg orally every 12 hours (maximum 750 mg/dose)
|
Alternative regimen | Clindamycin - 600 mg orally every 8 hours
| Clindamycin - 7 to 10 mg/kg orally every 6 to 8 hours (maximum 600 mg/dose)
|
PLUS | PLUS |
Quinine sulfate¥ - 650 mg orally every 8 hours
| Quinine sulfate¥ - 8 mg/kg orally every 8 hours (maximum 650 mg/dose)
|
Highly immunocompromised patientsΔΔ |
| Begin as summarized above for patients with severe acute disease, then continue with a step-down regimen once symptoms have improved and parasitemia has declined. When oral azithromycin is used, a higher dose (500 to 1000 mg orally once daily) may be administered. Highly immunocompromised patients should be treated for at least 6 consecutive weeks, including 2 final weeks during which parasites are no longer detected on peripheral blood smear. | |