Drug | Loading dose1 | Maintenance dose | Comments |
---|---|---|---|
Regimen 1 | Â | Â | Â |
Quinine dihydrochloride salt (available outside the USA), reconstituted in 5% glucose or normal saline | 7 mg salt/kg iv over 30 min followed immediately by maintenance dose OR20 mg salt/kg over 4 hours, followed 8 hours later by maintenance dose | 10 mg salt/kg diluted in10 ml/kg isotonic fluid iv over4 hours repeated every 8 hours2 | If hemodialysis is performed, then quinine is administered after dialysis. Monitor blood glucose because of risk for developing hyperinsulinemic hypoglycemia |
PLUS (either concurrently or immediately thereafter) | |||
Doxycycline3 | Not required | 1.5 mg/kg (usually 100 mg) po or iv every 12 hours for 7 days | Should not be given to pregnant or breast-feeding women or children < 8 years old |
Regimen 2 | Â | Â | Â |
Quinidine gluconate(available in the USA), reconstituted in normal saline | 10 mg salt/kg (equivalent to6.2 mg base/kg) iv infused over 1–2 hours, followed immediately by maintenance dose | 0.02 mg/kg/min salt (equivalent to 0.0125 mg/kg/min base) continuous iv infusion2 | Electrocardiographic monitoring is mandatory; slow or stop infusion if QRS lengthens >25% of baseline value or QTc interval > 500 ms |
PLUS (either concurrently or immediately thereafter) | Â | Â | Â |
Doxycycline3 | Not required | Same as above | Â |
Regimen 3 | Â | Â | Â |
Artesunate | 2.4 mg/kg iv bolus | 1.2 mg/kg iv daily4 | Artesunic acid 60 mg is dissolved in 0.6 ml 5% sodium bicarbonate, diluted to 3–5 ml 5% glucose, and given immediately by iv bolus injection |
PLUS | Â | Â | Â |
Mefloquine | 15 mg/kg (750 mg) base | 10 mg/kg (500 mg) base po at 6–8 hours and (if >60 kg) followed by 5 mg/kg (250 mg) po at 16 hours | Total dose: 1500 mg |
Regimen 4 | Â | Â | Â |
Artemether | 3.2 mg/kg im | 1.6 mg/kg im daily4 | Â |
PLUS | Â | Â | Â |
Mefloquine | Same as above | Same as above | Â |