What is the dosing for anti-malarial (antimalarial) medication?

From the Guidelines

For the treatment of uncomplicated malaria, the recommended dosing is based on the specific Plasmodium species and the patient's weight, with artemisinin-based combination therapies (ACTs) like dihydroartemisinin-piperaquine being a preferred treatment, given as 3 tablets per day for 3 days for patients weighing 36-75 kg, and 4 tablets per day for 3 days for patients weighing more than 75 kg, as stated in the study by 1. The choice of medication should account for the Plasmodium species involved, local resistance patterns, patient factors including pregnancy status, and potential drug interactions. Some key points to consider when choosing an anti-malarial medication include:

• The specific region of travel and local resistance patterns
• The Plasmodium species involved
• Patient factors, such as pregnancy status and potential drug interactions
• The need for proper timing and completion of the full course to maintain adequate blood levels and prevent resistance development For example, for patients with uncomplicated P. falciparum malaria, the study by 1 recommends the following dosing regimens:
• Dihydroartemisinin-piperaquine: 3 tablets per day for 3 days for patients weighing 36-75 kg, and 4 tablets per day for 3 days for patients weighing more than 75 kg
• Artemether-lumefantrine: 4 tablets per day on day 1,4 tablets per day on day 2, and 4 tablets per day on day 3, with the total dose being 24 tablets over 72 hours
• Atovaquone-proguanil: 4 tablets per day for 3 days for patients weighing more than 40 kg, and 3 tablets per day for 3 days for patients weighing less than 40 kg It's also important to note that the study by 1 provides guidance on the treatment of complicated malaria, including the use of intravenous artesunate, and the management of patients with severe malaria. Additionally, the study by 1 provides information on the treatment of malaria in special populations, such as pregnant women, and the use of alternative medications, such as quinine and mefloquine. Overall, the treatment of malaria requires careful consideration of the specific patient population, the Plasmodium species involved, and the local resistance patterns, as well as the potential risks and benefits of different medications, as discussed in the studies by 1 and 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.

The dosing for ant-malarial medication mefloquine is as follows:

• For adults:
  • Treatment: 1250 mg as a single oral dose
  • Prophylaxis: 250 mg once weekly
• For pediatric patients:
  • Treatment: 20 to 25 mg/kg body weight, with a maximum dose not exceeding the adult dose 2

From the Research

Dosing for Ant-Malarial Medication

The dosing for ant-malarial medication, specifically artemisinin-based combination therapy (ACT), is a crucial aspect of treating uncomplicated falciparum malaria.

• The World Health Organization (WHO) recommends the use of ACT, with artemether/lumefantrine being a prequalified fixed-dose combination 3.
• The standard dosing regimen for artemether/lumefantrine is a six-dose regimen, with the medication administered over three days 3, 4.
• For children, a dispersible formulation of artemether/lumefantrine is available, which can be easily administered by caregivers 3, 4.
• Alternative ACT regimens, such as artesunate-mefloquine, have also been shown to be effective and safe in treating uncomplicated falciparum malaria in children younger than 5 years 5.

Specific Dosing Recommendations

• The dosing of artemether/lumefantrine is typically based on the patient's weight, with the recommended dose being 1-2 tablets (20 mg artemether and 120 mg lumefantrine) twice a day for three days 3, 4.
• For artesunate-mefloquine, the recommended dose is 1-2 tablets (25 mg artesunate and 55 mg mefloquine) once a day for three days 5.
• It is essential to follow the recommended dosing regimen to ensure the efficacy and safety of the medication.

Considerations for Dosing

• The efficacy and safety of ant-malarial medications can be affected by various factors, including concurrently administered drugs, malnutrition, and co-infections with HIV and helminths 6.
• The emergence of artemisinin-resistant parasites in Southeast Asia highlights the need to optimize drug dosing and investigate novel therapies to maintain the reduction in malaria mortality 7.
• Further research is needed to address the challenges associated with the deployment of ant-malarial medications, particularly in resource-poor settings.