What is the recommended treatment for a 1.2-year-old child diagnosed with Plasmodium (malaria) falciparum?

Treatment of Plasmodium falciparum in a 1.2-year-old Child

For a 1.2-year-old child diagnosed with Plasmodium falciparum malaria, the recommended first-line treatment is artemisinin-based combination therapy (ACT), specifically artemether-lumefantrine or dihydroartemisinin-piperaquine, with appropriate weight-based dosing. 1

Assessment of Severity

First, determine if the child has uncomplicated or severe malaria:

Signs of Severe Malaria (requiring hospitalization):

• Severe anemia
• Hemoglobinuria, oliguria, or anuria
• Hypotension and respiratory distress
• Jaundice
• Hemorrhagic diatheses
• Cerebral malaria (drowsiness, mental confusion, coma, seizures)
• Hypoglycemia
• Parasitemia >5% in non-immune patients 1

Treatment Algorithm

For Uncomplicated P. falciparum Malaria:

1. First-line therapy (oral):

   • Artemether-lumefantrine (20 mg + 120 mg): For a child weighing 5-<15 kg, give 1 tablet at 0,8,24,36,48, and 60 hours (total of 6 doses over 3 days)
   • OR Dihydroartemisinin-piperaquine: For a child weighing 5-10 kg, give 1/8 tablet (40 mg/5 mg) once daily for 3 days 1

2. Administration considerations:

   • Artemether-lumefantrine must be given with fatty food or milk to enhance absorption
   • Dihydroartemisinin-piperaquine should be given in fasting condition 1
   • Tablets may be crushed and suspended in a small amount of water or milk for easier administration 2

3. If vomiting occurs:

   • If within 30 minutes of dose: repeat the full dose
   • If 30-60 minutes after dose: give half the dose
   • If vomiting persists: consider parenteral therapy 1

For Severe P. falciparum Malaria:

1. Immediate hospitalization with parenteral therapy:

   • Intravenous quinine: Loading dose 20 mg/kg over 4 hours, followed by 10 mg/kg every 8 hours 1
   • Monitor for hypoglycemia, which is a common complication of both severe malaria and quinine treatment

2. Supportive care:

   • Maintain hydration with IV fluids (5% dextrose with 1/2 normal saline at 10 mL/kg over 3 hours)
   • Monitor blood glucose regularly
   • Control fever with paracetamol
   • Treat seizures according to pediatric protocols 1

3. Blood transfusion: Consider if hemoglobin <4 g/dL or <6 g/dL with signs of respiratory distress 1

4. Switch to oral therapy: Once the child can tolerate oral medication and shows clinical improvement, complete treatment with a full course of oral ACT 1

Monitoring

• Check parasitemia daily until negative
• Monitor hemoglobin, glucose, and renal function
• Assess for clinical improvement (fever resolution, improved consciousness)
• Follow up after completion of therapy to ensure cure 1

Important Considerations

• ACTs are the preferred treatment due to their rapid parasite clearance and good safety profile 1
• Avoid mefloquine in children under 3 months or weighing less than 5 kg due to limited data 2
• Do not use steroids for cerebral malaria as they can worsen outcomes 1
• If no improvement within 48-72 hours of starting treatment, consider alternative therapy or drug resistance 2

Prompt and appropriate treatment is crucial as P. falciparum can rapidly progress to severe disease in young children, with high morbidity and mortality if not properly managed.