Artemesinin derivatives: (First Line treatment)
Artesunate: 2.4 mg/kg IV stat and followed by 2.4 mg/kg at 0, 12 and 24 hours, then 2.4 mg/kg daily maximum 5 days, if the patient is able to swallow, the daily dose of ACT can be given orally.
Artemether: 3.2 mg/kg (loading dose) IM followed by 1.6 mg/kg daily for 5 days. If the patient can swallow, the daily dose of ACT can be given orally.
Oral follow on treatment:
ACT [Oral Artemether+Lumefantrine]: (After IV Artesunate/ IM artemether only). Dose- 6 doses
N.B.:
- Patient of less than 20 kg IV Artesunate should be started with dose of 3mg/kg stat.
- IV Artesunate dose will be remain same for organ dysfunction (e.g. renal failure, hepatic failure etc)
- ACT should be taken immediately after food or a fat containing drink (e.g. milk)
Quinine: (If Artemesinin are not available)
Loading dose: Quinine dihydrochloride 20 mg salt/kg of body weight (loading dose) by infusion over 4 hours in 5% dextrose saline (5-10 ml/kg of body weight depending on the patients overall fluid balance).
Maintenance dose: 8 to 12 hours after the start of the loading dose, give a maintenance dose of Quinine 10 mg salt/kg of body weight in dextrose saline diluted as above over 4 hours. This maintenance dose should be repeated every 8-12 hours, calculated from the beginning of the previous infusion until the patient can take oral medication ( e.g. 08 hrs, 16 hrs, 24 hrs).
Oral Quinine: Quinine sulphate 10mg salt/kg, 8 hourly to complete a 7 days course of treatment (IV+Oral) with additional Tetracycline/ Doxycycline/ Clindamycin during oral follow on treatment.
N.B.:
ACT is preferable during follow on treatment than Q+T/D/C even after IV quinine therapy in SM. If ACT is not available then only Q+T/D/C should be chosen for follow on treatment.
