Version May 2024
| Type of infection | Trimester | Drug and dose |
| Chloroquine-resistant P. falciparum infection¶ All malarious regions except those specified as chloroquine sensitive listed in the box below. Middle Eastern countries with chloroquine-resistant P. falciparum include Iran, Oman, Saudi Arabia, and Yemen. | First trimester | Artemether-lumefantrine: 1 tablet = 20 mg artemether and 120 mg lumefantrine. A three-day treatment schedule with a total of six oral doses is recommended based on weight (25 to 34 kg: 3 tablets per dose; ≥35 kg: 4 tablets per dose). The patient should receive the initial dose, followed by the second dose 8 hours later, then 1 dose orally twice daily for the following two days. Take after a full meal or whole milk. or Other artemisinin combination therapy (dosing below) can be used as alternate therapy if artemether-lumefantrine is not available or is associated with treatment failure. or Quinine plus clindamycin:
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| Second or third trimester | Artemisinin combination therapy – One of the following:◊
or Quinine plus clindamycin (dosing above). | |
| Chloroquine-sensitive P. falciparum infection Central America west of Panama Canal; Haiti; the Dominican Republic; and most of the Middle East. Infections acquired in the Newly Independent States of the former Soviet Union and Korea to date have been uniformly caused by Plasmodium vivax and should therefore be treated as chloroquine-sensitive infections. | Any trimester | Chloroquine: 600 mg base (= 1000 mg salt) orally immediately, followed by 300 mg base (= 500 mg salt) orally at 6, 24, and 48 hours. Total dose: 1500 mg base (= 2500 mg salt).¥ or Hydroxychloroquine: 620 mg base (= 800 mg salt) orally immediately, followed by 310 mg base (= 400 mg salt) orally at 6, 24, and 48 hours. Total dose: 1550 mg base (= 2000 mg salt). |
* These regimens may be used for treatment of uncomplicated P. falciparum malaria in pregnant women or for completion of treatment for severe malaria following administration of parenteral therapy (for at least 24 hours and until oral medication can be tolerated). (Refer to the UpToDate table summarizing parenteral regimens for treatment of severe malaria in pregnancy.)
¶ Issues related to antimalarial selection for pregnant women are discussed further in the text. For pregnant women with uncomplicated chloroquine-resistant P. falciparum malaria, atovaquone-proguanil or mefloquine-based regimens may be used if other treatment options are not available or are not tolerated and if the potential benefit is judged to outweigh the potential risks. Similarly, for pregnant women with uncomplicated chloroquine-resistant P. falciparum or chloroquine-resistant P. vivax infection, doxycycline or tetracycline may be used in combination with quinine (as recommended for nonpregnant adults) if other treatment options are not available or are not tolerated and if the benefit is judged to outweigh the risks . Refer to the UpToDate topic on treatment of uncomplicated malaria in pregnancy for further discussion.
Δ For infections acquired in Southeast Asia, quinine treatment should continue for 7 days. For infections acquired elsewhere, quinine treatment should continue for 3 days. In the United States, quinine is encapsulated in a 324 mg (sulfate salt) dose; therefore, for adult dosing, 2 capsules are sufficient.
◊ Oral artesunate and clindamycin are also an alternate therapy in any trimester of pregnancy; however, combination tablets are not available.
§ Piperaquine component prolongs the QT interval by approximately the same amount as chloroquine but by less than quinine; avoid use in patients with congenital QT prolongation or who are on medications that prolong the QT interval. Dihydroartemisinin-piperaquine may be taken with food but should not be taken with a high-fat meal.
¥ The dosing for chloroquine summarized in the table is based on the recommendations of the United States Centers for Disease Control and Prevention. The dosing for chloroquine recommended by the World Health Organization consists of the following: Total dose: 25 mg base/kg, administered as 10 mg base/kg orally on day 1 followed by 10 mg/kg orally on day 2, and 5 mg/kg base on day 3.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
