TABLE 9-1 Treatment of Uncomplicated Malariaa

Malaria

Drug Treatment

P. vivax, P. malariae, P. ovale, known chloroquine-sensitive P. falciparuma

Chloroquine 10 mg base/kg stat. Followed by:

  1. 5 mg/kg at 12, 24 and 36 h; or

  2. 10 mg/kg at 24 h, 5 mg/kg at 48 h or Amodiaquine 10 mg base/kg/day for 3 days1

Chloroquine-resistant P. falciparuma known to be sensitive to sulfadoxinepyrimethamine (SP)

Pyrimethamine 1.25 mg/kg + sulfadoxine 25 mg/kg (single dose; 3 tablets in an adult) or Amodiaquine 10 mg base/kg/day for 3 days

Chloroquine-resistant P. vivaxb and multidrug resistant P. falciparuma

 

  1. Oral Artesunate 4 mg/kg daily for 3 days + mefloquine 25 mg base/kg (15 mg/kg on day 2, 10 mg/kg on day 3)

  2. Artemether-lumefantrine 1.5/9 mg/kg twice daily for 3 days with food

  3. Quinine 10 mg salt/kg three times daily plus tetracycline 4 mg/kg four times daily or doxycycline 3 mg/kg once daily or clindamycin 10 mg/kg twice daily for 7 days2

aFor acute treatment of falciparum malaria combinations containing an artemisinin-derivative are preferred. Artesunate (4 mg/kg/day for 3 days) has been combined successfully with chloroquine, amodiaquine, SP, mefloquine, and atovaquone-proguanil.

bThis refers to truly resistant P. vivax infections, which are a significant problem only in Oceania and Indonesia and should not be confused with relapses. Amodiaquine is more effective than chloroquine for resistant P. vivax.

Basic Properties of Antimalarials: Pharmacokinetics and Pharmacodynamics
Pharmacokinetics

The interactions of drugs with people who take them—how the compounds are absorbed, metabolized, distributed, and excreted—is referred to as pharmacokinetics. Antimalarial drugs differ considerably in their pharmacokinetics, which affect how well they work, how they are dosed, and how long they must be taken. People also vary in how they respond to drugs. Some of these responses are genetically determined, others by health status, others by dietary factors. In general, the pharmacokinetic properties of the antimalarials are similar in children and adults, although the metabo-



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