Version June 2024
| Drug | Adult dose | Pediatric dose (not to exceed adult dose) |
| Preferred regimens¶ | ||
| Artemisinin combination therapy | Regimens and doses summarized in separate table | Regimens and doses summarized in separate table |
| ChloroquineΔ | Doses 1 and 2 (2nd dose administered at 24 hours): 1000 mg salt (= 600 mg base) orally Dose 3 (3rd dose administered at 48 hours): 500 mg salt (= 300 mg base) orally per dose (Total dose: 2500 mg salt [= 1500 mg base]) | Doses 1 and 2 (2nd dose administered at 24 hours): 16.7 mg salt/kg (10 mg base/kg) orally Dose 3 (3rd dose administered at 48 hours): 8.3 mg salt/kg (5 mg base/kg) orally per dose (Total dose: 41.6 mg salt/kg [25 mg base/kg]; maximum total dose: 2500 mg salt [= 1500 mg base]) |
| Alternative regimens | ||
| HydroxychloroquineΔ◊ | Doses 1 and 2 (2nd dose administered at 24 hours): 800 mg salt (= 620 mg base) orally Dose 3 (3rd dose administered at 48 hours): 400 mg salt (= 310 mg base) orally per dose (Total dose: 2000 mg salt [= 1550 mg base]) | Doses 1 and 2 (2nd dose administered at 24 hours): 12.9 mg salt/kg (10 mg base/kg) orally Dose 3 (3rd dose administered at 48 hours): 6.5 mg salt/kg (= 5 mg base/kg) orally per dose (Total dose: 32.4 mg salt/kg [25 mg base/kg]; maximum total dose 2000 mg salt [= 1550 mg base]) |
| Atovaquone-proguanil§ Adult tab = 250 mg atovaquone/100 mg proguanil Pediatric tab = 62.5 mg atovaquone/25 mg proguanil | 4 adult tabs orally once daily for 3 days | 5 to <8 kg: 2 pediatric tabs orally once daily for 3 days 8 to <10 kg: 3 pediatric tabs orally once daily for 3 days 10 to <20 kg: 1 adult tab orally once daily for 3 days 20 to <30 kg: 2 adult tabs orally once daily for 3 days 30 to <40 kg: 3 adult tabs orally once daily for 3 days ≥40 kg: 4 adult tabs orally once daily for 3 days |
| Quinine sulfate¥ Plus one of the following: | United States: Quinine sulfate 648 mg salt¥ (= 538 mg base) orally 3 times daily for 3 or 7 days† Canada, European Union, United Kingdom: Quinine sulfate 600 mg salt¥ (= 500 mg base) orally 3 times daily for 3 or 7 days† | Quinine sulfate:¥ 10 mg salt/kg (= 8.3 mg base/kg) orally 3 times daily for 3 or 7 days† |
| Plus one of the following: | Plus one of the following: | |
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| Mefloquine** | 500 mg salt (= 456 mg base) orally once daily for 3 days or 8 mg salt/kg (= 7.3 mg base/kg) orally once daily for 3 days, whichever is less. (Total maximum dose: 1500 mg salt [= 1369 mg base] in equally divided doses over 3 days) | 8 mg salt/kg (= 7.3 mg base/kg) orally once daily for 3 days; maximum 500 mg salt (= 456 mg base) per dose (Total dose: 24 mg salt/kg (= 22 mg base/kg); maximum 1500 mg salt [= 1369 mg base] in equally divided doses over 3 days) |
CDC: United States Centers for Disease Control and Prevention; G6PD: glucose-6-phosphate dehydrogenase; ACT: artemisinin combination therapy; WHO: World Health Organization.
* For treatment of infection due to Plasmodium vivax and Plasmodium ovale, presumptive antirelapse therapy to eradicate the hypnozoite liver stages should be administered after normal G6PD status has been confirmed; options for antirelapse therapy include primaquine or tafenoquine. Refer to the UpToDate topics for further discussion.
¶ The approach to antimalarial selection depends on a number of factors including species diagnosis and likelihood of chloroquine resistance. Preferred regimens for treatment of chloroquine-sensitive non-falciparum malaria consist of chloroquine or ACT. Preferred regimens for treatment of chloroquine-resistant non-falciparum malaria consist of ACT. If an antimalarial is taken for chemoprophylaxis, a different drug should be used for treatment.
Δ In the United States and Canada, pill strengths for chloroquine and hydroxychloroquine are labeled in salt; in many other countries, pill strengths are labeled in base. 250 mg chloroquine phosphate (salt) is equivalent to 150 mg chloroquine base; 200 mg hydroxychloroquine sulfate (salt) is equivalent to 155 mg hydroxychloroquine base.
◊ Hydroxychloroquine is appropriate only for treatment of chloroquine-susceptible infection.
§ Take with food or whole milk. If the patient vomits within 30 minutes of taking a dose, then they should repeat the dose. It is also acceptable to take one-half of the dose twice daily.
¥ In the United States and Canada, pill strengths for quinine are labeled as quinine sulfate (salt); in many other countries, pill strengths are labeled in quinine base. 324 mg quinine sulfate (salt) = 269 mg quinine base. Pediatric dosing may require compounding pharmacy, since noncapsule forms of quinine are not available in the United States.
‡ Tetracycline antibiotics may cause permanent tooth discoloration for children <8 years if used repeatedly. However, doxycycline binds less readily to calcium than other tetracyclines and may be used for ≤21 days in children of all ages.[1]
† For infections acquired in Southeast Asia, quinine treatment should continue for 7 days. For infections acquired elsewhere, quinine treatment should continue for 3 days.
** Mefloquine should be used only if other options are not available, and it is not recommended for children <15 kg or in patients with neuropsychiatric history. The dosing regimen for mefloquine outlined above is in alignment with the WHO[2], which differs from the CDC approach; the WHO approach is associated with greater bioavailability and is better tolerated[3]. In the United States and Canada, pill strengths for mefloquine are labeled in hydrochloride salt; in many other countries, pill strengths are labeled in mefloquine base. 250 mg mefloquine hydrochloride (salt) is equivalent to 228 mg mefloquine base.Adapted from: United States Centers for Disease Control and Prevention. Guidelines for Treatment of Malaria in the United States: https://www.cdc.gov/malaria/resources/pdf/malaria_treatment_table_202302c.pdf (Accessed on September 5, 2023). CDC Malaria Hotline: (770) 488-7788 Monday to Friday 8:00 am to 4:30 pm EST; (770) 488-7100 after hours, weekends, and holiday.
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