From the Guidelines
For the treatment of uncomplicated P. falciparum malaria, artemisinin-based combination therapies (ACTs) such as dihydroartemisinin-piperaquine or artemether-lumefantrine are the first-line choice, due to their rapid parasite clearance and good safety profile, as supported by recent studies 1. The recommended regimen for dihydroartemisinin-piperaquine is 36 to 75 kg: 3 tablets per day for 3 days, and for >75 kg: 4 tablets per day for 3 days, while for artemether-lumefantrine, the dosing is based on weight, with >35 kg: day 1: 4 tablets (H0), 4 tablets (H8) day 2: 4 tablets (H36, H48); day 3: 4 tablets (H60, H72) 1. Some key points to consider when using ACTs include:
- They must be taken with a fatty meal or drink to enhance absorption
- They have a rapid onset of action
- They are generally well-tolerated, but can cause adverse reactions such as headache, vertigo, and digestive disorders
- They should be avoided in patients at risk of QTc prolongation and with comedication that prolongs QTc
- Alternative treatments, such as atovaquone-proguanil or mefloquine, may be considered in cases where ACTs are contraindicated or not available 1. It's also important to note that the treatment of malaria should always be guided by the specific species of Plasmodium, the severity of the disease, and the patient's individual characteristics, such as pregnancy or comorbidities, as highlighted in recent studies 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Malaria Treatment in Adults Treatment of mild to moderate malaria in adults caused by mefloquine-susceptible strains of P. falciparum or by P. vivax: Dosage: Five tablets (1250 mg) mefloquine hydrochloride USP to be given as a single oral dose. Malaria Prophylaxis in Adults Dosage: One 250 mg mefloquine hydrochloride tablet once weekly. Malaria Treatment in Pediatric Patients Treatment of mild to moderate malaria in pediatric patients caused by mefloquine-susceptible strains of P. falciparum: Dosage: 20 to 25 mg/kg body weight. Malaria Prophylaxis in Pediatric Patients The recommended prophylactic dose of mefloquine hydrochloride is approximately 5 mg/kg body weight once weekly.
The anti-malaria medication protocol for adults and pediatric patients is as follows:
- For malaria treatment in adults: a single oral dose of 1250 mg mefloquine hydrochloride.
- For malaria prophylaxis in adults: 250 mg mefloquine hydrochloride once weekly.
- For malaria treatment in pediatric patients: 20 to 25 mg/kg body weight.
- For malaria prophylaxis in pediatric patients: approximately 5 mg/kg body weight once weekly 2.
From the Research
Anti-Malaria Medication Protocol
The current recommended treatment for uncomplicated falciparum malaria is artemisinin-based combination therapy (ACT), with artemether/lumefantrine (AL) being the only fixed-dose ACT pre-qualified by the World Health Organization (WHO) 3.
Efficacy of Artemether/Lumefantrine
- The efficacy of AL has been consistently high in sub-Saharan Africa, with PCR-corrected cure rates above 95% 4.
- A study in northern Zambia found a genotype-corrected therapeutic efficacy of 98.8% for AL in the treatment of uncomplicated falciparum malaria 5.
- However, a study in Sweden reported a high rate of treatment failures with AL in nonimmune travelers, particularly in European men, with an effectiveness of only 73.7% in this group 6.
Safety and Administration
- AL has a complex treatment regimen and issues of adherence to treatment, particularly in resource-poor settings 3.
- The absorption of lumefantrine is dependent on the presence of food in the stomach, and intake of about 1.5 g of fat seems sufficient for satisfactory absorption 7.
- AL can cause gastrointestinal and neurological disorders, and lumefantrine can prolong the QT interval, warranting ECG monitoring and blood potassium assays in some patients 7.
Resistance and Recurrence
- Recurrent episodes of malaria after treatment with AL can be due to recrudescence or reinfection, and genotyping can help distinguish between the two 6, 5.
- Drug resistance markers, such as single nucleotide polymorphisms (SNPs) and multidrug resistance protein 1 (mdr1) copy number variation, can be detected but may not correlate with parasite recurrence 5.