CDC Malaria Hotline: (770) 488-7788 or (855) 856-4713 toll-free Monday-Friday 9 am to 5 pm EST -(770) 488-7100 after hours, weekends and holidays Clinical Diagnosis/ Plasmodium species Region Infection Acquired Recommended Drug and Adult Dose 1 Recommended Drug and Pediatric Dose 1 Pediatric dose should NEVER exceed adult dose Uncomplicated malaria/ P. falciparum or Species not identified If "species not identified" is subsequently diagnosed as P. vivax or P ovale: see P. vivax and P ovale (below) re. treatment with primaquine Chloroquine-resistant or unknown resistance 2 (All malarious regions except those specified as chloroquine-sensitive listed in the box below.) A. Atovaquone-proguanil (MalaroneTM) 3 Adult tab = 250 mg atovaquone/ 100 mg proguanil 4 adult tabs po qd x 3 days A. Atovaquone-proguanil (MalaroneTM) 3 Adult tab = 250 mg atovaquone/ 100 mg proguanil Peds tab = 62.5 mg atovaquone/ 25 mg proguanil 5 -8kg: 2 peds tabs po qd x 3 d 9-10kg: 3 peds tabs po qd x 3 d 11-20kg: 1adult tab po qd x 3 d 21-30kg: 2 adult tabs po qd x 3d 31-40kg: 3 adult tabs po qd x 3d > 40 kg: 4 adult tabs po qd x 3d B. Artemether-lumefantrine (CoartemTM) 3 1 tablet = 20mg artemether and 120 mg lumefantrine A 3-day treatment schedule with a total of 6 oral doses is recommended for both adult and pediatric patients based on weight. The patient should receive the initial dose, followed by the second dose 8 hours later, then 1 dose po bid for the following 2 days. 5 -<15 kg: 1 tablet per dose 15 -<25 kg: 2 tablets per dose 25 -<35 kg: 3 tablets per dose 35 kg: 4 tablets per dose C. Quinine sulfate plus one of the following: Doxycycline, Tetracycline, or Clindamycin Quinine sulfate: 542 mg base (=650 mg salt) 4 po tid x 3 or 7 days 5 Doxycycline: 100 mg po bid x 7 days Tetracycline: 250 mg po qid x 7 days Clindamycin: 20 mg base/kg/day po divided tid x 7 days C. Quinine sulfate 4 plus one of the following: Doxycycline 6 , Tetracycline 6 or Clindamycin Quinine sulfate: 8.3 mg base/kg (=10 mg salt/kg) po tid x 3 or 7 days 5 Doxycycline: 2.2 mg/kg po every 12 hours x 7 days Tetracycline: 25 mg/kg/day po divided qid x 7 days Clindamycin: 20 mg base/kg/day po divided tid x 7 days D. Mefloquine (LariamTM and generics) 7 684 mg base (=750 mg salt) po as initial dose, followed by 456 mg base (=500 mg salt) po given 6-12 hours after initial dose Total dose= 1,250 mg salt D. Mefloquine (LariamTM and generics) 7 13.7 mg base/kg (=15 mg salt/kg) po as initial dose, followed by 9.1 mg base/kg (=10 mg salt/kg) po given 6-12 hours after initial dose. Total dose= 25 mg salt/kg 89#
Chloroquine phosphate (AralenTM and generics) 8 600 mg base (=1,000 mg salt) po immediately, followed by 300 mg base (=500 mg salt) po at 6, 24, and 48 hours Total dose: 1,500 mg base (=2,500 mg salt) OR Hydroxychloroquine (Plaquenil TM and generics) 620 mg base (=800 mg salt) po immediately, followed by 310 mg base (=400 mg salt) po at 6, 24, and 48 hours Total dose: 1,550 mg base (=2,000 mg salt) 10 NOTE: There are three options (A, B, or C) available for treatment of uncomplicated malaria caused by chloroquine-resistant P. vivax. High treatment failure rates due to chloroquine-resistant P. vivax have been well documented in Papua New Guinea and Indonesia. Rare case reports of chloroquine-resistant P. vivax have also been documented in Burma (Myanmar), India, and Central and South America. Persons acquiring P. vivax infections outside of Papua New Guinea or Indonesia should be started on chloroquine. If the patient does not respond, the treatment should be changed to a chloroquine-resistant P. vivax regimen and CDC should be notified (Malaria Hotline number listed above). For treatment of chloroquine-resistant P. vivax infections, options A, B, and C are equally recommended. 11 For pregnant women diagnosed with uncomplicated malaria caused by chloroquine-resistant P. falciparum or chloroquine-resistant P. vivax infection, treatment with doxycycline or tetracycline is generally not indicated. However, doxycycline or tetracycline may be used in combination with quinine (as recommended for non-pregnant adults) if other treatment options are not available or are not being tolerated, and the benefit is judged to outweigh the risks. 12 Atovaquone-proguanil and artemether-lumefantrine are generally not recommended for use in pregnant women, particularly in the first trimester due to lack of sufficient safety data. For pregnant women diagnosed with uncomplicated malaria caused by chloroquine-resistant P. falciparum infection, atovaquone-proguanil or artemether-lumefantrine may be used if other treatment options are not available or are not being tolerated, and if the potential benefit is judged to outweigh the potential risks. 13 For P. vivax and P. ovale infections, primaquine phosphate for radical treatment of hypnozoites should not be given during pregnancy. Pregnant patients with P. vivax and P. ovale infections should be maintained on chloroquine prophylaxis for the duration of their pregnancy. The chemoprophylactic dose of chloroquine phosphate is 300 mg base (=500 mg salt) orally once per week. After delivery, pregnant patients who do not have G6PD deficiency should be treated with primaquine.

# All regions
Quinidine gluconate 14 plus one of the following: Doxycycline, Tetracycline, or Clindamycin Quinidine gluconate: 6.25 mg base/kg (=10 mg salt/kg) loading dose IV over 1-2 hrs, then 0.0125 mg base/kg/min (=0.02 mg salt/kg/min) continuous infusion for at least 24 hours. An alternative regimen is 15 mg base/kg (=24 mg salt/kg) loading dose IV infused over 4 hours, followed by 7.5 mg base/kg (=12 mg salt/kg) infused over 4 hours every 8 hours, starting 8 hours after the loading dose (see package insert). Once parasite density <1% and patient can take oral medication, complete treatment with oral quinine, dose as above. Quinidine/quinine course = 7 days in Southeast Asia; = 3 days in Africa or South America.
Doxycycline: Treatment as above. If patient not able to take oral medication, give 100 mg IV every 12 hours and then switch to oral doxycycline (as above) as soon as patient can take oral medication. For IV use, avoid rapid administration. Treatment course = 7 days.
Tetracycline: Treatment as above Clindamycin: Treatment as above. If patient not able to take oral medication, give 10 mg base/kg loading dose IV followed by 5 mg base/kg IV every 8 hours. Switch to oral clindamycin (oral dose as above) as soon as patient can take oral medication. For IV use, avoid rapid administration. Treatment course = 7 days.

# Investigational new drug (contact CDC for information):
Artesunate followed by one of the following: Atovaquoneproguanil (MalaroneTM), Doxycycline (Clindamycin in pregnant women), or Mefloquine Quinidine gluconate 14 plus one of the following: Doxycycline 4 , Tetracycline 4 , or Clindamycin Quinidine gluconate: Same mg/kg dosing and recommendations as for adults.
Doxycycline: Treatment as above. If patient not able to take oral medication, may give IV. For children 45 kg, use same dosing as for adults. For IV use, avoid rapid administration. Treatment course = 7 days.
Tetracycline: Treatment as above Clindamycin: Treatment as above. If patient not able to take oral medication, give 10 mg base/kg loading dose IV followed by 5 mg base/kg IV every 8 hours. Switch to oral clindamycin (oral dose as above) as soon as patient can take oral medication. For IV use, avoid rapid administration. Treatment course = 7 days.

# Investigational new drug (contact CDC for information):
Artesunate followed by one of the following: Atovaquone-proguanil (MalaroneTM), Clindamycin, or Mefloquine