General: Always in consultation with a (paediatric) infectious diseases specialist
Uncomplicated Plasmodium falciparum infection:
Asexual P. falciparum parasitaemia < 2% and no dividing forms in the blood. The patient is not vomiting and has no signs of complications, such as neurological symptoms, renal insufficiency, jaundice, dyspnoea, shock, disseminated intravascular coagulation, acidosis, etc.
Severe or complicated P. falciparum infection:
If one or more of the following points are present
Parasitaemia >2%
Dividing forms in the blood
The patient is vomiting
Evidence of complications, such as neurological symptoms, renal insufficiency, jaundice, dyspnoea, shock, disseminated intravascular coagulation, acidosis, etc.
NB: Parasitaemia on the blood smear may underestimate the true parasitaemia due to sequestration of infected erythrocytes. In case of doubt, even if parasitaemia is <2%, always treat as severe or complicated P. falciparum infection
Do not use if the patient has used atovaquone/proguanil for prophylaxis.
Severe or complicated P. falciparum malaria
1st choice Artesunate 2.4 mg/kg intravenously at T 0, 12, 24, 48 and 72 hours. As soon as possible, switch to oral therapy. Maximum 5 days. Always complete treatment with a full oral course of artemether/lumefantrine or atovaquone/proguanil. No dose adjustment required for renal or hepatic impairment.
NB 1: A medical declaration is required for artesunate
NB 2: Coombs-negative haemolysis has been reported up to several weeks after administration of artesunate for severe malaria. Therefore, it is recommended to check for haemolysis weekly for at least 4 weeks after the start of treatment.
In pregnancy:
For severe or complicated P. falciparum malaria: in all trimesters give artesunate 2.4 mg/kg IV as soon as possible at T 0, 12, 24, 48 and 72 hours. As soon as possible, switch to oral therapy (in principle artemether/lumefantrine).
For uncomplicated P. falciparum malaria: in all trimesters artemether/lumefantrine (Riamet®, Coartem®) orally
General: Always in consultation with a (paediatric) infectious diseases specialist
Uncomplicated Plasmodium falciparum infection:
Severe or complicated P. falciparum infection:
If one or more of the following points are present
NB: Parasitaemia on the blood smear may underestimate the true parasitaemia due to sequestration of infected erythrocytes. In case of doubt, even if parasitaemia is <2%, always treat as severe or complicated P. falciparum infection
Uncomplicated P. falciparum malaria
1st choice Combination product artemether/lumefantrine (Riamet®, Coartem®) orally: tablets 20 mg artemether and 120 mg lumefantrine orally.
≥ 35 kg: 4 tablets at T = 0, 8, 24, 36, 48 and 60 hours. Take with fatty food or milk. Do not give if the patient has used mefloquine for prophylaxis.
2nd choice: Combination product atovaquone/proguanil (Malarone®) orally: tablets containing atovaquone 250 mg and proguanil 100 mg.
>40 kg: once daily 4 tablets for 3 days.
Do not use if the patient has used atovaquone/proguanil for prophylaxis.
Severe or complicated P. falciparum malaria
1st choice Artesunate 2.4 mg/kg intravenously at T 0, 12, 24, 48 and 72 hours. As soon as possible, switch to oral therapy. Maximum 5 days. Always complete treatment with a full oral course of artemether/lumefantrine or atovaquone/proguanil. No dose adjustment required for renal or hepatic impairment.
NB 1: A medical declaration is required for artesunate
NB 2: Coombs-negative haemolysis has been reported up to several weeks after administration of artesunate for severe malaria. Therefore, it is recommended to check for haemolysis weekly for at least 4 weeks after the start of treatment.
In pregnancy:
For severe or complicated P. falciparum malaria: in all trimesters give artesunate 2.4 mg/kg IV as soon as possible at T 0, 12, 24, 48 and 72 hours. As soon as possible, switch to oral therapy (in principle artemether/lumefantrine).
For uncomplicated P. falciparum malaria: in all trimesters artemether/lumefantrine (Riamet®, Coartem®) orally