RIDU specific malaria guidance

This guidance is a supplement to the general malaria treatment guidance, which can be found here.

Non-severe malaria treatment - additional information for ID

1. Falciparum malaria (Falciparum, mixed species, or species not characterised)

1. If no criteria for severe disease present, go to Table 1.
2. If vivax/ovale co-infection confirmed, go to Table 1 + Table 3.
3. If treatment failure (recrudescence) go to Table 4.

2. Non-falciparum malaria (vivax, ovale, malariae, knowlesi).

1. If no criteria for severe disease present, go to Table 2.
2. If vivax or ovale, go to Table 2 + Table 3.

3. No evidence of malaria (a single negative film does not exclude malaria).

1. Blood film daily for 2 more days.
2. Malaria is unlikely with 3 negative films.
3. See Fever in the returning traveller guidance.

	Drug, dose	Timing, duration
First line therapy	Artemether with lumefantrine (Riamet^®*) - weight greater than 35kg: 4 tablets - weight less than or equal to 35kg: discuss with ID consultant	at 0, 8, 24, 36, 48 & 60 hrs
If first line therapy not available	Atovaquone-proguanil (Malarone^®) - 4 ‘standard’ tablets	once daily for 3 days
	Dihydroartemisinin–piperaquine (DHA-PPQ; piperaquine/artenimol) - weight greater than 60 kg: 4 tablets, - weight 36 to 60 kg: 3 tablets	once daily for 3 days
	Quinine 600 mg + Doxycycline 200 mg* (if not pregnant)/ Clindamycin 450 mg* (if pregnant)	8hrly for 7 days + 24hrly for 7 days 8hrly for 7 days

* All pregnant and breast-feeding patients should be discussed with the ID consultant oncall and pharmacist.

Drug, dose

Timing, duration

First line therapy

Artemether with lumefantrine (Riamet^®*)

- weight greater than 35kg: 4 tablets

- weight less than or equal to 35kg: see box 8 in full guidance (link in references)

at 0, 8, 24, 36, 48 & 60 hrs

If first line therapy not available

Dihydroartemisinin–piperaquine (DHA-PPQ; piperaquine/artenimol),

- weight >60 kg: 4 tablets

- weight 36-60 kg: 3 tablets

once daily for 3 days

* All pregnant and breast-feeding patients should be discussed with the ID consultant oncall and pharmacist.

G6PD status	Drug, dose, route	Timing, duration
First ensure G6PD screen requested and result checked.
No G6PD deficiency	Non-pregnant/breast-feeding: vivax: primaquine 30 mg ovale: primaquine 15 mg	Once daily for 14 days
No G6PD deficiency	Pregnant/breast-feeding: vivax/ovale: chloroquine 310 mg (no longer available)	Weekly until primaquine can be given safely, then follow primaquine dose above.
Mild/moderate G6PD deficiency	Non-pregnant/breast-feeding: vivax/ovale: primaquine 45 mg	Weekly for 8 weeks
Mild/moderate G6PD deficiency	Pregnant/breast-feeding: vivax/ovale: chloroquine 310 mg (no longer available)	Weekly until primaquine can be given safely, then follow primaquine dose above.
Severe G6PD	Requires discussion with haematology. Eradication of hypnozoites usually not possible and relapses treated as per Table 2.