Hesperian Health Guides

More Medicines Used for Malaria

Chloroquine


In most of the world, malaria is now resistant to chloroquine. Find out which medications work best in your area. If you do not know which type of malaria a person has, it is best to treat with Artemisinin Combination Therapy (ACT).

When treating malaria with chloroquine, you will also need primaquine to prevent the malaria from coming back.

In a few countries where malaria is not resistant to it, chloroquine by itself is used to prevent malaria. In countries where the resistance is low, chloroquine combined with proguanil is sometimes used to prevent malaria.

Chloroquine is safe for women who are pregnant or breastfeeding for both prevention and treatment of malaria.

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May cause mild dizziness, nausea, vomiting, abdominal pain, itching.

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If the dose is too high, chloroquine is very dangerous, especially to children.

Do not use if the person has epilepsy.

Use with caution if the person has diabetes.

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Take with food.

Chloroquine comes in two forms, chloroquine phosphate and chloroquine sulfate. The active part of the chloroquine is called the base.

Dose by body weight. The total of chloroquine base given over 3 days is 25 mg/kg as follows:  

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Day 1: 10 mg chloroquine base per kg
Day 2: 10 mg chloroquine base per kg
Day 3: 5 mg chloroquine base per kg


Chloroquine phosphate tablets usually come in 250 mg tablets (with 150 mg chloroquine base).

Chloroquine sulfate tablets usually come in 200 mg tablets (with 155 mg chloroquine base).

Be sure you know which type of chloroquine you have and how much chloroquine base is in it (tablet strength).

To treat uncomplicated malaria that is not resistant to chloroquine

Using chloroquine phosphate 250 mg tablets (150 mg chloroquine base) OR using chloroquine sulfate 200 mg tablets (155 mg chloroquine base):

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Give one dose on day 1 and again on day 2:
Less than 8 kg: ½ tablet
8 kg to 15 kg: 1 tablet
16 kg to 30 kg: 2 tablets
31 kg to 45 kg: 3 tablets
46 kg and over: 4 tablets


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On day 3, give half of the day 1 dose:
Less than 8 kg: ¼ tablet
8 kg to 15 kg: ½ tablet
16 kg to 30 kg: 1 tablets
31 kg to 45 kg: 1½ tablets
46 kg and over: 2 tablets

To prevent vivax malaria where it is not resistant to chloroquine

For prevention, take chloroquine once a week beginning 1 or 2 weeks before travel. Continue one dose each week while you are there and for 4 weeks after leaving the malaria region. Give the dose used for day 3 of treatment shown above. For example, for prevention an adult takes weekly either 2 tablets of chloroquine phosphate with 150 mg chloroquine base or 2 tablets of chloroquine sulfate with 155 mg chloroquine base.

To prevent falciparum malaria where resistance to chloroquine is low

For travelers to countries where there is some resistance to chloroquine but the medicine still works, chloroquine is taken once a week while also taking proguanil once a day to prevent malaria. Start both medicines 1 week before travel. Continue one dose each week while you are there and for 4 weeks after leaving the malaria region. Take the chloroquine the same day each week and the proguanil the same time each day. Take with food.

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Using chloroquine tablets with either 155 mg or 150 mg chloroquine base and proguanil tablets with 100 mg of proguanil hydrochloride:
1 to 4 years old: ½ tablet proguanil each day and ½ tablet chloroquine each week
5 to 8 years old: 1 tablet proguanil each day and 1 tablet chloroquine each week
9 to 14 years old: 1 and ½ tablet proguanil each day and 1 and ½ tablet chloroquine each week
15 years and older: 2 tablets proguanil each day and 2 tablets chloroquine each week

Primaquine


Primaquine is used for 14 days along with or right after treatment with chloroquine to prevent returning fever attacks from malaria types that are not falciparum.

In some regions, a single dose of primaquine is given on the first day of the 3-day ACT treatment for falciparum malaria. This helps keep falciparum from spreading to others.

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Primaquine is not given to women who are pregnant or breastfeeding a baby 6 months or younger.

Primaquine is usually not given to children younger than 1 year old.

For people with a blood condition called G6PD deficiency (favism), an experienced health worker uses a lower dose of primaquine, spread out over many weeks.

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Upset stomach and stomach pain.

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Take with food.

Primaquine phosphate is a common form of primaquine. Often tablets contain 15 mg of primaquine base, the active part of the medicine.

To keep non-falciparum malaria from returning in the same person, use with or right after treatment with chloroquine

Dose by weight or if you cannot weigh the child, dose by age.

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Using tablets with 15 mg primaquine base, give:
10 kg to 24 kg (3 to 7 years): ¼ tablet each day for 14 days
25 kg to 49 kg (8 to 11 years): ½ tablet each day for 14 days
50 kg and over (12 years and older): 1 tablet each day for 14 days

To keep falciparum malaria from spreading, where falciparum is not common

In some regions, adding a single dose of primaquine to ACT treatment is recommended to keep malaria from spreading.

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On the first day of the 3-day ACT treatment. and using tablets with 15 mg primaquine base, give:
10 kg to 24 kg (3 to 7 years): ¼ tablet one time
25 kg to 49 kg (8 to 11 years): ½ tablet one time
50 kg and over (12 years and older): 1 tablet one time

Proguanil and Atovaquone + proguanil


Proguanil is usually for malaria prevention by travelers. Proguanil is always used with another malaria medicine.

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Can cause headache, cough, diarrhea, and mild upset stomach.

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People with serious kidney problems should not use proguanil.

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Take with food.

Proguanil and chloroquine together are used to prevent malaria in areas where there is low resistance to chloroquine.

Atovaquone and proguanil come as a fixed-dose combination tablet. It is mostly used to prevent malaria but in countries where ACT and other malaria medicines no longer work, it is sometimes used to treat malaria in combination with artesunate and primaquine.

Tablets contain:
62.5 mg atovaquone + 25 mg proguanil (for children)
250 mg atovaquone + 100 mg proguanil (for adults)

To prevent malaria

Both adults and children take one dose each day beginning 1 or 2 days before travel. Continue one dose each day while you are there and for 7 days after leaving the malaria region.

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Using tablets made for children with 62.5 mg atovaquone + 25 mg proguanil, give:
5 kg to 7 kg: ½ tablet each day
8 kg to 9 kg: ¾ tablet each day
10 to 19 kg: 1 tablet each day
20 kg to 29 kg: 2 tablets each day
30 kg to 39 kg: 3 tablets each day
40 kg and over: 4 children’s tablets OR 1 adult tablet each day.

Quinine, injections


Severe malaria is a medical emergency. A quinine injection into the muscle is sometimes used to treat a person before sending her to the hospital. Quinine injections should only be given by an experienced health worker who knows the correct dose and how to give it. For children with severe malaria, if injectable artesunate is not available, it is safer to use artesunate suppositories instead of quinine on the way to get treatment.

Quinine sulfate, tablets


Quinine tablets by mouth are used to treat uncomplicated malaria where chloroquine does not work.

For women in the first 3 months of pregnancy, use both quinine and clindamycin to treat falciparum malaria. For vivax malaria that is resistant to chloroquine, use quinine alone.

The combination of quinine and either clindamycin or doxycycline is sometimes used if an ACT is not available to finish treating the person following emergency care for severe malaria.

Quinine is not used to prevent malaria.

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Quinine sometimes causes sweaty skin, ringing of the ears or problems with hearing, blurred vision, dizziness, nausea and vomiting, and diarrhea.

If the person is vomiting up the quinine, an anti-nausea medicine such as promethazine may help.

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Taking too much quinine is dangerous. Quinine can cause blood sugar levels to drop too low. Get medical help for danger signs such as dizziness, confusion, loss of consciousness, or the heart beating too fast or too slow.

Do not use quinine if taking chloroquine or mefloquine.

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Treat with quinine for 3 or 7 days, depending on the region. Clindamycin or doxycycline may also be needed.

Quinine sulfate, quinine hydrochloride, and quinine dihydrochloride come in tablets of 300 mg and their dose is the same. By body weight, the dose is 10 mg of quinine sulfate per kg taken 3 times a day. Quinine bisulfate tablets, however, have a different dose: 14 mg per kg taken 3 times a day.

To treat uncomplicated chloroquine-resistant falciparum malaria

Depending on where you live, treatment will be for 3 or 7 days.

Dose by body weight.

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Using quinine sulfate, quinine hydrochloride, and quinine dihydrochloride tablets of 300 mg, give:
7 to 11 kg: ¼ tablet, 3 times a day
12 to 24 kg: ½ tablet, 3 times a day
25 to 34 kg: 1 tablet, 3 times a day
35 to 49 kg: 1½ tablets, 3 times a day
50 kg and over: 2 tablets, 3 times a day


Also take clindamycin or doxycycline for 7 days starting on day 2 or day 3 after starting the quinine, when the person is less likely to vomit the medicines. For dosing of doxycycline, see below.

For clindamycin: the dose each day is 20 mg per kg of body weight for 7 days, divided into 2 doses per day, depending on the strength of the capsules.

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Using clindamycin capsules of 150 mg, give:
10 to 19 kg: 1 capsule (150 mg), 2 times a day, for 7 days
20 to 29 kg: 2 capsules (300 mg), 2 times a day, for 7 days
30 to 44 kg:3 capsules (450 mg), 2 times a day, for 7 days
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Using clindamycin capsules of 300 mg, give:
45 kg and over: 2 capsule (600 mg), 2 times a day, for 7 days


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If you develop watery or bloody diarrhea, stop taking clindamycin immediately.

Because the drug can pass through breast milk to a baby, avoid giving clindamycin to breastfeeding women.

Do not take antacids for 2 hours before or after taking clindamycin. They make the medicine less effective.

To treat uncomplicated chloroquine-resistant vivax malaria

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Use quinine sulfate and either clindamycin or doxycycline as for chloroquine-resistant falciparum malaria (see above). After that treatment, add 14 days of primaquine. But do not add primaquine for a pregnant woman.

Doxycycline


Doxycycline is an antibiotic with many uses. It can be used to treat malaria when combined with quinine. Doxycycline is also used to prevent malaria for travelers.

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Heartburn, stomach cramps, diarrhea, and yeast infections are common.

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Pregnant women and children under 8 years old should avoid doxycycline or tetracycline because these medicines can damage or stain teeth and bones.

Use with caution for a person with kidney, liver, stomach diseases or with gastritis.

Avoid iron pills and antacids for 2 hours before or after taking doxycycline. They will make the medicine less effective.

Avoid spending time in the sun while taking doxycycline to prevent sunburn and skin rash.

Doxycycline may make birth control pills less effective. If possible use another birth control method (such as condoms) while taking this medicine.

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Take doxycycline with a full cup of water. Take with food if it upsets your stomach.

To use with quinine to treat uncomplicated chloroquine-resistant malaria

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For uncomplicated falciparum malaria, start doxycycline 1 or 2 days after starting the quinine or as soon as the person can take the medicine without vomiting:
Child over 8 years but under 40 kg: 50 mg, 2 times each day, for 7 days
Child over 40 kg and adults: 100 mg, 2 times each day, for 7 days


Also give quinine.

To use with quinine to treat uncomplicated vivax malaria

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Give the doxycycline and quinine as above, and when finished, also take primaquine for 14 days.

To prevent malaria for travel to areas with malaria:

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Both adults and children take one dose of doxycycline each day beginning a day or two before travel. Continue one dose each day while you are there and for 28 days after leaving the malaria region.
Child over 8 years but under 40 kg: 50 mg one time each day
Child over 40 kg and adults: 100 mg one time each day



This page was updated:25 Nov 2019