Artemether Dosing for Malaria Treatment
For uncomplicated P. falciparum malaria, artemether-lumefantrine (AL) should be dosed as 4 tablets (20/120 mg) at 0 hours, 4 tablets at 8 hours on day 1, then 4 tablets twice daily on days 2 and 3 (total of 24 tablets over 72 hours) for adults >35 kg, and must be taken with a fatty meal or drink to ensure adequate absorption. 1, 2, 3
Standard Dosing Regimen for Uncomplicated Malaria
The artemether-lumefantrine dosing schedule is weight-based: 1
- 5-<15 kg: 1 tablet per dose
- 15-<25 kg: 2 tablets per dose
- 25-<35 kg: 3 tablets per dose
- ≥35 kg (adults): 4 tablets per dose
Timing: Doses given at 0,8,24,36,48, and 60 hours (6 doses total over 3 days). 1
Critical Administration Requirements
Fat intake is mandatory for adequate lumefantrine absorption. Failure to take AL with a fatty meal or drink results in subtherapeutic drug levels and treatment failure. 1, 2, 3 The medication should be administered with at least 200 mL of milk or a fatty meal to optimize bioavailability. 4
Day 7 lumefantrine concentrations ≥200 ng/mL are associated with >98% cure rates in most patients with parasitemia <135,000/μL. 5 Unsupervised treatment results in 44% lower day 7 concentrations, emphasizing the importance of directly observed therapy when possible. 5
High-Risk Populations Requiring Close Monitoring
Three groups face increased treatment failure risk and warrant enhanced monitoring: 5
- Very young children (<3 years): Particularly underweight-for-age children who have 23% lower day 7 concentrations than adequately nourished children and 53% lower concentrations than adults. 5
- Patients with high parasitemia (>135,000/μL): Baseline parasitemia increases recrudescence risk (HR 1.87 per 10-fold increase). 5
- Patients in areas with emerging artemisinin resistance or very low transmission intensity. 5
Pregnancy Considerations
Artemether-lumefantrine can be used in all trimesters of pregnancy as recommended by WHO and CDC, with cure rates of 99.3% demonstrated in second and third trimester studies. 1, 2, 3 The standard adult dosing regimen applies, with no dose adjustment needed. 1
Severe Malaria
For severe malaria, intravenous artesunate is first-line treatment at 2.4 mg/kg IV at 0,12, and 24 hours, then daily until parasitemia <1%. 2, 3 Once the patient can tolerate oral medication and parasitemia is <1%, complete treatment with a full course of oral artemether-lumefantrine. 2, 3
Important Safety Considerations
QTc prolongation risk: Both artemether and lumefantrine can prolong the QTc interval. Avoid in patients at risk of QTc prolongation or taking medications that prolong QTc. 1, 2, 3
Post-artemisinin delayed hemolysis (PADH): Monitor hemoglobin on days 7,14,21, and 28 after treatment, as PADH occurs in 37.4% of patients using strict definitions. 2, 6
Alternative Dosing Considerations
Swiss guidelines recommend extending treatment to 5 days in patients with high body weight or suspected malabsorption. 2 However, once-daily dosing is not recommended, as it results in 30% lower lumefantrine exposure and reduced efficacy. 4