Treatment

Medication guideline

Uncomplicated malaria first choice:
- Artesunate + Amodiaquine — tablet — 2 tablets 100 mg + 270 mg PO once daily 3 days — (Uncomplicated malaria.)

Severe malaria first choice:
- Artesunate — injection — 2.4 mg/kg IV/IM 0, 12, 24 h then daily until able to swallow — (Severe malaria.)

Severe malaria alternative:
- Artemether — injection — 3.2 then 1.6 mg/kg IM on admission then daily until able to swallow — (Severe malaria alternative.)
- Quinine — IV infusion — 20 then 10 mg/kg IV infusion loading then q8h until able to switch — (Severe malaria alternative: loading dose over 4 h, then maintenance dose q8h over 4 h.)

Add-on supportive care:
- Paracetamol — tablet — 500-1000 mg PO q4-6h PRN — (For fever or pain; max 4 g/day.)
- Ibuprofen — tablet — 200-400 mg PO q6-8h PRN — (For fever or pain; max 2.4 g/day.)

Hypoglycaemia management:
- Dextrose 50% diluted 1:1 with normal saline — IV solution — 1 ml/kg IV slow stat over 3-5 min — (Correct hypoglycaemia if present. Recheck blood glucose every 2-4 h, especially in comatose patients.)
- Dextrose 10% — IV solution — 5 ml/kg IV slow stat over 3-5 min — (Alternative correction for hypoglycaemia if present.)

Convulsion management:
- Diazepam — injection/rectal — 0.3 IV or 0.5-1 rectal mg/kg IV/rectal stat if convulsions >5 min — (Max 10 mg for adults when IV.)
- Paraldehyde — injection — 0.1 ml/kg IM stat as needed — (Alternative anticonvulsant when indicated.)
- Phenytoin — injection — 20 mg/kg IV loading dose stat — (Alternative anticonvulsant loading dose when indicated.)

Transfusion / bleeding management:
- Packed cells or whole blood — blood product — clinical indication IV as prescribed as needed — (Transfuse when severe anaemia with shock/acidosis or anticipated critical Hb drop due to high parasitaemia.)
- Fresh whole blood or platelets — blood product — clinical indication IV as prescribed as needed — (If spontaneous bleeding and products are available.)

Medications (guideline)

First line

Artesunate — injection — 2.4 mg/kg IV/IM 0, 12, 24 h then daily until able to swallow — (Severe malaria.)
Artesunate + Amodiaquine — tablet — 2 tablets 100 mg + 270 mg PO once daily 3 days — (Uncomplicated malaria.)

Other / supportive

Paracetamol — tablet — 500-1000 mg PO q4-6h PRN — (For fever or pain; max 4 g/day.)
Ibuprofen — tablet — 200-400 mg PO q6-8h PRN — (For fever or pain; max 2.4 g/day.) (Alternative)
Diazepam — injection/rectal — 0.3 IV or 0.5-1 rectal mg/kg IV/rectal stat if convulsions >5 min — (Max 10 mg for adults when IV.)
Paraldehyde — injection — 0.1 ml/kg IM stat as needed — (Alternative anticonvulsant when indicated.) (Alternative)
Phenytoin — injection — 20 mg/kg IV loading dose stat — (Alternative anticonvulsant loading dose when indicated.) (Alternative)
Dextrose 50% diluted 1:1 with normal saline — IV solution — 1 ml/kg IV slow stat over 3-5 min — (Correct hypoglycaemia if present. Recheck blood glucose every 2-4 h, especially in comatose patients.)
Dextrose 10% — IV solution — 5 ml/kg IV slow stat over 3-5 min — (Alternative correction for hypoglycaemia if present.) (Alternative)
Artemether — injection — 3.2 then 1.6 mg/kg IM on admission then daily until able to swallow — (Severe malaria alternative.) (Alternative)
Quinine — IV infusion — 20 then 10 mg/kg IV infusion loading then q8h until able to switch — (Severe malaria alternative: loading dose over 4 h, then maintenance dose q8h over 4 h.) (Alternative)
Packed cells or whole blood — blood product — clinical indication IV as prescribed as needed — (Transfuse when severe anaemia with shock/acidosis or anticipated critical Hb drop due to high parasitaemia.)
Fresh whole blood or platelets — blood product — clinical indication IV as prescribed as needed — (If spontaneous bleeding and products are available.) (Alternative)

Drug management