View source for New Where There Is No Doctor:Medicines for Malaria:Mosquito

{{bctrail|segments=3|chapterurl=Chapter_22:_Malaria,_Dengue,_and_Other_Illnesses_from_Mosquitoes|chaptitle=Malaria, Dengue, and Other Illnesses from Mosquitoes|}}
{{DISPLAYTITLE:Medicines for Malaria}}
{{SideSupplement|bookabbreviation=nwtnd||pagealt=is from the<br> Advance Chapters of the|notforsale=true|chapterpdf=http://hesperian.org/wp-content/uploads/pdf/en_nwtnd_2011/en_nwtnd_2019_22a.pdf|booktitle=NEW Where There Is No Doctor}}
{{chaptertoc|Malaria, Dengue, and Other Illnesses from Mosquitoes: Medicines|
<ul class{{=}}"noprint">
<li>[[New_Where_There_Is_No_Doctor:Medicine for Pain and Fever:Mosquito|Medicine for Pain and Fever]]</li>
<li>[[New_Where_There_Is_No_Doctor:Medicines for Malaria:Mosquito|Medicines for Malaria]]</li>
<li>[[New_Where_There_Is_No_Doctor:More Medicines Used for Malaria:Mosquito|More Medicines Used for Malaria]]</li>
</ul>}}
===About malaria medicines===
There are many medicines to treat and prevent malaria. But malaria parasites can develop resistance to medicines, meaning some no longer kill the parasites. Health workers, local health centers, or the government health authority know what medicines will work best in your area. 

====Medicines used to prevent malaria====
[[#mef|Mefloquine]], [[New_Where_There_Is_No_Doctor:More_Medicines_Used_for_Malaria:Mosquito#chlor|chloroquine]], [[New_Where_There_Is_No_Doctor:More_Medicines_Used_for_Malaria:Mosquito#candp|chloroquine and proguanil]], [[New_Where_There_Is_No_Doctor:More_Medicines_Used_for_Malaria:Mosquito#pap|atovaquone + proguanil]], and [[New_Where_There_Is_No_Doctor:More_Medicines_Used_for_Malaria:Mosquito#doxy|doxycycline]], are medicines used for prevention when people travel to regions with malaria from an area without malaria.

[[New_Where_There_Is_No_Doctor:More_Medicines_Used_for_Malaria:Mosquito#prim|Primaquine]] is used to prevent repeat attacks of some types of malaria after the malaria has been treated.

Monthly doses of amodiaquine with sulfadoxine + pyrimethamine are used in some Sahel region countries in Africa during the rainy season to prevent malaria in children under 5. 

In other countries (also in Africa), malaria is prevented in infants by giving 3 doses of sulfadoxine + pyrimethamine in the first year of life. Usually they are given at the same time as common vaccinations. 

In some countries, monthly doses of [[#sulf|sulfadoxine + pyrimethamine]] are used to prevent malaria in pregnancy.

====Medicines to treat severe malaria====
[[New_Where_There_Is_No_Doctor:Malaria#sev|Severe malaria]] needs emergency treatment with IV or injectable artesunate. Once the person has been treated and stopped vomiting, they will also need 3 days of artemisinin-based combination (ACT) medicines by mouth (see the list of 5 common ACT medicines below).

If emergency artesunate by injection is not available, a child with severe malaria who is vomiting can be given [[#supp|artesunate capsule suppositories]] (in the rectum) on the way to a health center. This can save the child’s life.

<div class{{=}}page-break></div>
====Medicines to treat uncomplicated malaria from ''P. falciparum''====
The parasite P. falciparum causes malaria that is more likely to become [[New_Where_There_Is_No_Doctor:Malaria#sev|severe]]. Depending on the region, chloroquine or other malaria medicines no longer work to treat falciparum malaria. Instead, use ACT (Artemisinin-based Combination Therapy) medicines. Use only the medicines that work in your area. Take ACT medicines for 3 days. See [[New_Where_There_Is_No_Doctor:Medicines_for_Malaria:Mosquito#act|Using ACT medicines]]. Common ACT combinations are:

*'''[[#aandl|Artemether + lumefantrine]]''' 
*'''[[#aanda|Artesunate + amodiaquine]]''' 
*'''[[#aandm|Artesunate + mefloquine]]''' 
*'''[[#asp|Artesunate with sulfadoxine + pyrimethamine]]'''
*'''[[#dandp|Dihydroartemisinin + piperaquine]]'''

====Medicines to treat uncomplicated malaria that is not from ''P. falciparum''====
Several malaria parasites cause uncomplicated malaria. Use ACT (Artemisinin-based Combination Therapy) if you don’t know which type of malaria it is, or if the person could have 2 types of malaria at once. If the malaria where you live is resistant to chloroquine, you will need to find out which ACT will work instead.

If chloroquine still works to treat non-falciparum uncomplicated malaria where you live, it may be more available than ACT. [[New_Where_There_Is_No_Doctor:More_Medicines_Used_for_Malaria:Mosquito#prim|Primaquine]] is often used together with [[New_Where_There_Is_No_Doctor:More_Medicines_Used_for_Malaria:Mosquito#chlor|chloroquine]] to cure the malaria more completely. 

====Medicines to treat malaria in pregnant women====
For severe malaria, pregnant women need emergency treatment in a hospital or clinic with the same medicines used for any other adult.

To treat uncomplicated malaria in the first 3 months of pregnancy, use [[New_Where_There_Is_No_Doctor:More_Medicines_Used_for_Malaria:Mosquito#qstabs|quinine and clindamycin]]. If a malaria test shows the uncomplicated malaria is caused by the vivax parasite, or if you do not have clindamycin, use only quinine. 

To treat uncomplicated malaria for a woman whose pregnancy is more than 3 months, use the ACT or other medicines that work well in your area.

Quinine, chloroquine, clindamycin, and proguanil are also safe during pregnancy. Do not use primaquine during pregnancy. 

In some regions, pregnant women take [[#sulf|sulfadoxine + pyrimethamine]] starting at week 13 of the pregnancy. Taking one dose per month for the rest of the pregnancy is called intermittent preventive treatment. This will stop malaria before it causes harm to the pregnancy or to the mother. 
<div class{{=}}page-break></div>
====For all malaria medicines====
Malaria may cause vomiting. Repeat the dose of medicine if you vomit within 60 minutes of taking it. 

Take the malaria medicines for the full number of days, even if you already feel better. This is needed to kill all the malaria parasites. If the treatment is causing vomiting or if it is hard to give a child the medicine, talk to a health worker.

Even after starting treatment with medicines, watch for danger signs of [[New_Where_There_Is_No_Doctor:Malaria#sev|severe malaria]], especially in children and in women who are pregnant or have just given birth.
<div id=act></div>

===Artemisinin-based Combination Therapy (ACT)===
{{spannote|||
====Using ACT medicines====
Some ACT come as single tablets combining 2 medicines (called fixed-dose combination tablets or coformulated tablets). Or they may come in a blister pack with 2 different tablets for each dose.
*Do not remove the tablets from the blister packaging until ready to use. Once a tablet is taken from the blister, use right away.
*If the 3-day treatment of ACT does not stop the malaria attack, try a different combination ACT. However, if the fevers and other signs return after 4 weeks, it is probably a new case of malaria.
*In regions where malaria transmission is low, health authorities may recommend a single dose of [[New_Where_There_Is_No_Doctor:More_Medicines_Used_for_Malaria:Mosquito#prim|primaquine]] together with the 3-day treatment of ACT.}}
<div id=aandl></div>
===Artemether + lumefantrine===
<hr>
Artemether and lumefantrine come as a fixed-dose combination tablet. 
 
It is used to treat uncomplicated falciparum malaria, for other malaria types, and following emergency treatment of severe malaria. 

This ACT combination medicine is not used to prevent malaria.
{{NWTNDgreen|Side effects}}
Can cause nausea, stomach upset, dizziness, headache.

{{NWTNDgreen|Important}}
To treat women for uncomplicated malaria in the first 3 months of pregnancy, give quinine and clindamycin where available instead of ACT combinations.

If you have heart problems, talk to an experienced health worker before taking this medicine.
<div class{{=}}page-break></div>
{{NWTNDgreen|How to pill}}
Take with a full meal or with milk. Fat in the food helps the body use the medicine.

Tablets contain:<div style="padding-left:18px;>20 mg of artemether + 120 mg of lumefantrine</div>
<div style="padding-left:18px;>40 mg of artemether + 240 mg of lumefantrine</div>

====To treat uncomplicated malaria====
Dose by body weight.

[[Image:NWTND_bag_arrow.png|13px|left]]Using tablets of 20 mg of artemether and 120 mg of lumefantrine, give:<br>'''5 kg to 14 kg:''' 1 tablet, 2 times a day, for 3 days
<div style="padding-left:18px;>'''15 kg to 24 kg: '''2 tablets, 2 times a day, for 3 days</div>
<div style="padding-left:18px;>'''25 kg to 34 kg:''' 3 tablets, 2 times a day, for 3 days</div>
<div style="padding-left:18px;>'''35 kg and over:''' 4 tablets, 2 times a day, for 3 days</div>
<div id=aanda></div>
===Artesunate + amodiaquine===
<hr>
Artesunate and amodiaquine come as a fixed-dose combination tablet or are given as separate tablets at the same time.

It is used to treat uncomplicated falciparum malaria, other malaria types, and following emergency treatment of severe malaria. 

This ACT combination medicine is not used to prevent malaria.

{{NWTNDgreen|Side effects}}
Can cause itchy skin, upset stomach, headache, dizziness.

{{NWTNDgreen|Important}}
To treat women for uncomplicated malaria in the first 3 months of pregnancy, give quinine and clindamycin where available instead of ACT combinations.

Avoid giving to anyone taking zidovudine, efavirenz, or cotrimoxazole.

{{NWTNDgreen|How to pill}}
Tablets contain:<div style="padding-left:18px;>25 mg of artesunate + 67.5 mg amodiaquine</div>
<div style="padding-left:18px;>50 mg of artesunate + 135 mg amodiaquine<br>100 mg of artesunate + 270 mg amodiaquine</div>
<div class{{=}}page-break></div>
====To treat uncomplicated malaria====
Dose by body weight.

[[Image:NWTND_bag_arrow.png|13px|left]]Using tablets of 25 mg of artesunate and 67.5 mg of amodiaquine, give:<br>'''4.5 kg to 8 kg:''' 1 tablet each day, for 3 days.
<div style="padding-left:18px;>'''9 kg to 17 kg:''' 2 tablets each day, for 3 days</div>


[[Image:NWTND_bag_arrow.png|13px|left]]Using tablets of 100 mg of artesunate + 270 mg amodiaquine, give:<br>
<div style="padding-left:18px;>'''18 kg to 35 kg:''' 1 tablet each day, for 3 days.</div>
<div style="padding-left:18px;>'''36 kg and over:''' 2 tablets each day, for 3 days</div>
<div id=aandm></div>

===Artesunate + mefloquine===
<hr>
Artesunate and mefloquine come as a fixed-dose combination tablet or are given as separate tablets at the same time.

It is used to treat uncomplicated falciparum malaria and other malaria types. 

Mefloquine by itself can be used for malaria prevention for people who travel to malaria regions from an area without malaria. 

{{NWTNDgreen|Side effects}}
Can cause dizziness, stomach upset, headache, and sleeping and vision problems when
used to treat malaria.

Pregnant women may have more nausea with artesunate + mefloquine, so if available,
use a different ACT.

{{NWTNDgreen|Important}}
To treat women for uncomplicated malaria in the first 3 months of pregnancy, give quinine and clindamycin where available instead of ACT combinations.

Do not use mefloquine for infants under 3 months or weighing less than 5 kg.

Mefloquine should not be taken by persons with epilepsy or mental illness or severe kidney problems.
 
If you have heart problems, talk to an experienced health worker before taking this medicine. 

Mefloquine sometimes causes strange behavior, confusion, anxiety, seizures or unconsciousness. If any of these signs develop, stop taking mefloquine immediately. If mefloquine had this effect on a person once, choose a different treatment if they get malaria again.
<div class{{=}}page-break></div>
{{NWTNDgreen|How to pill}}
Take with food.

Tablets contain:<div style="padding-left:18px;>25 mg of artesunate + 55 mg of mefloquine (for children)</div>
<div style="padding-left:18px;>100 mg of artesunate + 220 mg of mefloquine (for adults)</div>

====To treat uncomplicated malaria====
Dose by body weight.

[[Image:NWTND_bag_arrow.png|13px|left]]Using tablets with 25 mg of artesunate + 55 mg of mefloquine, give:<br>
<div style="padding-left:18px;>'''5 kg to 8 kg:''' 1 tablet each day, for 3 days</div>
<div style="padding-left:18px;>'''9 kg to 17 kg:''' 2 tablets each day, for 3 days</div>


[[Image:NWTND_bag_arrow.png|13px|left]]Using tablets with 100 mg of artesunate + 220 mg of mefloquine, give:<br>
<div style="padding-left:18px;>'''18 kg to 29 kg:''' 1 tablet each day, for 3 days</div>
<div style="padding-left:18px;>'''30 kg and over:''' 2 tablets each day, for 3 days</div>
<div id=mef></div>
====Mefloquine to prevent malaria:====
Comes in 250 mg mefloquine tablet

Take the dose once a week beginning 2 to 3 weeks before travel. Continue one dose each week while you are there and for 4 weeks after leaving the malaria region. Mefloquine is not recommended for infants under 5 kg.

[[Image:NWTND_bag_arrow.png|13px|left]]Using 250 mg tablets, give:<br>
<div style="padding-left:18px;>'''5 to 19 kg:''' &#188; tablet (63 mg) one time each week</div>
<div style="padding-left:18px;>'''20 to 29 kg:''' &#189; tablet (125 mg) one time each week</div>
<div style="padding-left:18px;>'''30 to 44 kg:''' &#190; tablet (188 mg) one time each week</div>
<div style="padding-left:18px;>'''45 kg and over:''' 1 tablet (250 mg) one time each week</div>
<div id=asp></div>
===Artesunate with sulfadoxine + pyrimethamine===
<hr>
Sulfadoxine and pyrimethamine come as a fixed-dose combination tablet and is used together with artesunate to treat uncomplicated falciparum malaria and other malaria types. 

Sulfadoxine + pyrimethamine is no longer recommended for treatment in some areas where it no longer works well. Check with your government health authority before using.

In countries where [[#sulf|sulfadoxine + pyrimethamine]] tablets are used to prevent malaria in pregnant women, monthly doses start at week 13 of the pregnancy.

{{NWTNDgreen|Side effects}}
Can cause stomach upset and skin rash.

{{NWTNDgreen|Important}}
To treat women for uncomplicated malaria in the first 3 months of pregnancy, give quinine and clindamycin where available instead of ACT combinations. 

For infants, use a different ACT.

Do not use sulfadoxine + pyrimethamine if you are already taking cotrimoxazole.

Sulfadoxine + pyrimethamine should not be taken by anyone who has ever had a reaction to a sulfa medicine. If the medicine causes a rash or itching, drink lots of water and do not take it again.

{{NWTNDgreen|How to pill}}
The sulfadoxine + pyrimethamine combination tablet comes in different strengths of each of the 2 medicines it contains.

====To treat uncomplicated malaria==== 
This ACT is a 3-day treatment as follows: on days 1, 2, and 3, give the dose of
artesunate. Also on day 1, give 1 dose of sulfadoxine + pyrimethamine.

Dose by body weight.

[[Image:NWTND_bag_arrow.png|13px|left]]Using tablets with 50 mg of artesunate tablet, give:<br>
<div style="padding-left:18px;>'''5 kg to 9 kg:''' &#189; tablet, 1 time each day, for 3 days</div>
<div style="padding-left:18px;>'''10 kg to 24 kg:''' 1 tablet, 1 time each day, for 3 days</div>
<div style="padding-left:18px;>'''25 kg to 50 kg:''' 2 tablets, 1 time each day, for 3 days</div>
<div style="padding-left:18px;>'''50 kg or over:''' 4 tablets, 1 time each day, for 3 days</div>


[[Image:NWTND_bag_arrow.png|13px|left]]Using tablets with 500 mg of sulfadoxine + 25 mg of pyrimethamine also give:<br>
<div style="padding-left:18px;>'''5 kg to 9 kg:''' &#189; tablet the first day only</div>
<div style="padding-left:18px;>'''10 kg to 24 kg:''' 1 tablet the first day only</div>
<div style="padding-left:18px;>'''25 kg to 50 kg:''' 2 tablets the first day only</div>
<div style="padding-left:18px;>'''50 kg or over:''' 3 tablets the first day only</div>


Women who are pregnant and are being treated with this ACT combination can continue a daily dose of 0.4 mg (400 mcg) of folic acid but not higher.  Too much folic acid interferes with the malaria medicine.
<div id=sulf></div>
<div class{{=}}page-break></div>

====Sulfadoxine + pyrimethamine is used to prevent malaria in pregnancy====
In some African countries, all pregnant women are given monthly doses of sulfadoxine + pyrimethamine because malaria is so common and so dangerous for the mother and for developing child. The monthly doses begin when the woman is 3 months pregnant. [[New_Where_There_Is_No_Doctor:Prevent_Illness_by_Stopping_Mosquitoes#bednet|Bednets]] also help prevent malaria during pregnancy and after the baby is born.
 
[[Image:NWTND_bag_arrow.png|13px|left]]Using tablets with 500 mg of sulfadoxine + 25 mg of pyrimethamine:
<div style="padding-left:18px;>During week 13 to 16 of the pregnancy, give the first dose of 3 tablets. One month later, give a second dose of 3 tablets. After another month, give a third dose of 3 tablets. Repeat each month until the 6th dose is reached or the child is born. Always wait at least one month between each dose.</div>


Some pregnant women may have nausea, vomiting, and dizziness when they take sulfadoxine + pyrimethamine, , especially with the first dose. 

Pregnant women also need iron and folic acid to keep the baby well and prevent anemia. If taking sulfadoxine + pyrimethamine each month for malaria prevention, take a daily dose of 0.4 mg (400 mcg) of folic acid but not higher. Too much folic acid interferes with the malaria medicine.  
<div id=dandp></div>

===Dihydroartemisinin + piperaquine===
<hr>
Dihydroartemisinin and piperaquine come as a fixed-dose combination tablet.

It is used to treat uncomplicated falciparum malaria, other malaria types, and following emergency treatment of severe malaria. 

This ACT combination medicine is not used to prevent malaria.
{{NWTNDgreen|Side effects}}
May cause a fast heartbeat, upset stomach, itching.

{{NWTNDgreen|Important}}
To treat women for uncomplicated malaria in the first 3 months of pregnancy, give quinine and clindamycin where available instead of ACT combinations. 

Do not use when taking erythromycin.

Use with caution with people over 60 years old, people with HIV taking antiretroviral medicines, or people with heart, kidney or liver problems.
<div class{{=}}page-break></div>
{{NWTNDgreen|How to pill}}
Take between meals with a full cup of water. Do not take with milk or food that has fat because this changes how well the medicine works.

Tablets contain:<div style="padding-left:18px;>20 mg of dihydroartemisinin + 160 mg of piperaquine (for children)</div>
<div style="padding-left:18px;>40 mg of dihydroartemisinin + 320 mg of piperaquine (for adults)</div>

Children that weigh less than 25 kg receive a dose based on 2.5 mg/kg for dihydroartemisinin and 20 mg/kg for piperaquine. This is a higher dose per kg than used with older children and adults.

====To treat uncomplicated malaria====
Dose by body weight.

[[Image:NWTND_bag_arrow.png|13px|left]]Using tablets with 20 mg of dihydroartemisinin + 160 mg of piperaquine, give:<br>
<div style="padding-left:18px;>'''5 kg to 7 kg:''' 1 tablet each day, for 3 days </div>
<div style="padding-left:18px;>'''8 kg to 10 kg:''' 1&#189; tablets each day, for 3 days </div>


[[Image:NWTND_bag_arrow.png|13px|left]]Using tablets with 40 mg of dihydroartemisinin + 320 mg of piperaquine, give: <br>
<div style="padding-left:18px;>'''11 kg to 16 kg:''' 1 tablet each day, for 3 days</div>
<div style="padding-left:18px;>'''17 kg to 24 kg:''' 1&#189; tablets each day, for 3 days</div>
<div style="padding-left:18px;>'''25 kg to 35 kg:''' 2 tablets each day, for 3 days</div>
<div style="padding-left:18px;>'''36 kg to 59 kg:''' 3 tablets each day, for 3 days</div>
<div style="padding-left:18px;>'''60 kg to 79 kg: '''4 tablets each day, for 3 days</div>
<div style="padding-left:18px;>'''80 kg and over:''' 5 tablets each day, for 3 days</div>
<div id=art></div>
===Artesunate===
<hr>
Artesunate is a medicine of the artemisinin family. To treat uncomplicated falciparum malaria, artesunate in tablet form is used in combination with one of these: [[#aanda|amodiaquine]], [[#mef|mefloquine]], or [[#sulf|sulfadoxine + pyrimethamine]]. Combining these medicines is called [[#act|Artemisinin Combination Therapy (ACT)]]. 

For emergency treatment with severe malaria, health workers use intravenous (IV) artesunate or artesunate injections in the muscle (IM) to treat severe malaria. After at least 24 hours of this treatment, and when the person is no longer vomiting, she will also need 3 days of ACT treatment taken by mouth. 

Artesunate injections are also for trained health workers to treat adults and children before transfer to a hospital that is far away. [[#supp|Artesunate also comes as suppositories]] that go in the rectum for children under 6 years old on the way to medical help. 

Artesunate is not used to prevent malaria.
<div class{{=}}page-break></div>
{{NWTNDgreen|Side effects}}
Artesunate can cause dizziness, headaches and stomach upset. 

{{NWTNDgreen|How to pill}}
====For uncomplicated falciparum malaria use with another medicine as part of ACT:====
Artesunate comes in 50 mg tablets. See above for the dose of [[#asp|artesunate and sulfadoxine + pyrimethamine]] when used as a part of ACT. For other ACT combinations, the artesunate is combined with the other medicine into a single tablet or comes in a blister package with the 2 tablets that are taken together.
<div id=supp></div>
====How to use artesunate suppositories for children with severe malaria:====
When a child 6 years or younger has signs of severe malaria, is vomiting, and is far from a health center that can treat her with intravenous (IV) artesunate or artesunate injections in the muscle (IM), use artesunate gelatin capsules (called suppositories) in the rectum on the way to get help. This can save her life. After putting the capsule in the rectum, hold the child’s buttocks together for about 10 minutes to make sure the capsule does not fall out. If it does come out within the first 30 minutes, repeat the dose. 

If the child weighs 5 to 10 kg, use one suppository of 100 mg, and if 10 kg or more, use 2 of the 100 mg capsules. If 50 mg suppository capsules are available, use only 1 for a baby that weighs under 5 kg. 

Emergency treatment does not cure malaria. The child will need more treatment by an experienced health worker. 





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