Dosing of anti-malarials that may be considered for presumptive or directed* treatment of Plasmodium falciparum malaria in sub-Saharan refugees after arrival in the United States

Dosing of anti-malarials that may be considered for presumptive or directed* treatment of Plasmodium falciparum malaria in sub-Saharan refugees after arrival in the United States

Medication	Child dosing children weighing 5 kg to <35 kg	Adult dosing adults and children weighing >35 kg
Presumptive therapy
Atovaquine-proguanil (adult tab = 250 mg atovaquone/100 mg proguanil; pediatric tab = 62.5 mg atovaquone/25 mg proquanil)	5 to 8 kg: 2 pediatric tablets once a day for three days 9 to 10 kg: 3 pediatric tablets once a day for three days 11 to 20 kg: 1 adult tablets once a day^¶ for three days 21 to 30 kg: 2 adult tablets once a day^¶ for three days 31 to 40 kg: 3 adult tablets once a day^¶ for three days >40 kg: 4 adult tablets once a day^¶ three days	4 adult tablets once a day^¶ for three days
Artemether-lumefantrine (20 mg artemether and 120 mg lumefantrine)	A six-dose regimen is recommended with 1 to 3 tablets per dose, depending on body weight: 5 to <15 kg: 1 tablet, then 1 tablet after eight hours, then 1 tablet twice daily (morning and evening) on each of the following two days (total course: 12 tablets) 15 to <25 kg: 2 tablets as a single dose, then 2 tablets after eight hours, then 2 tablets twice daily (morning and evening) on each of the following two days (total course: 18 tablets) 25 to <35 kg: 3 tablets as a single dose, then 3 tablets after eight hours, then 3 tablets twice daily (morning and evening) on each of the following two days (total course: 18 tablets)^Δ	A standard three-day treatment schedule with a total of six doses 4 tablets as a single dose, then 4 tablets after eight hours, then 4 tablets twice daily (morning and evening) on each of the following two days (total course: 24 tablets)
Alternatives that may be used as directed therapy*
Quinine sulfate	30 mg/kg/day divided in three doses for 3 days	650 mg every eight hours for 3 days^◊
plus clindamycin	20 to 40 mg/kg/day in three doses for 7 days	900 mg three times a day for 7 days^◊
or doxycycline^§	2 mg/kg/day for 7 days	100 mg twice a day for 7 days^◊
Other alternatives
Mefloquine^¥	<45 kg: 15 mg/kg then 10 mg/kg 12 hours later	750 mg then 500 mg 12 hours later^◊

* Directed therapy refers to treating after P. falciparum malaria has been detected by diagnostic examination in an asymptomatic individual. NOTE: more specific guidance can be found at: http://www.cdc.gov/malaria/diagnosis_treatment/index.html.
¶ May divide the dose and give one-half the dose in the morning and one-half in the evening for better gastrointestinal tolerance.
Δ Should be taken with foods rich in fat such as milk. If vomiting occurs within one hour after taking the medicine, another dose should be taken.
◊ Do not exceed adult dosing.
§ Not approved for use in children less than eight years.
¥ Should not be given together with quinine or quinidine. Common adverse effects include nausea, vomiting, diarrhea, dizziness, toxic psychosis, and seizures.

Reproduced from: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases. Domestic refugee health guidelines: Malaria. Centers for Disease Control and Prevention, Division of Global Migration and Quarantine 2012. Available at: http://www.cdc.gov/immigrantrefugeehealth/pdf/malaria-domestic.pdf.

Graphic 96455 Version 2.0

خرید پکیج

Dosing of anti-malarials that may be considered for presumptive or directed* treatment of Plasmodium falciparum malaria in sub-Saharan refugees after arrival in the United States