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| | Directions for use | Special notes |
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| Artemether-lumefantrine (Coartem®) | Orally, six doses over three days according to weight; extend to five days in patients >85 kg | Only indicated for cases of uncomplicated malaria; take with milk or fatty foods; for P. ovale and P. vivax infections, treatment should be followed by primaquine (not registered in SA; available as section 21) |
| Warnings/contraindications: caution advised in patients with porphyria or a history of QT abnormalities; coadministration with strong cytochrome P450 3A4 (CYP3A4) inducers may result in treatment failure |
| Side effects: sleep disturbances, headaches, dizziness, palpitations, abdominal pain, arthralgia, myalgia |
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| Quinine (Lennon-Quinine Sulphate® 300 mg tablets) | Orally, 10 mg quinine sulphate per kg body weight every 8 hours for 7 to 10 days | For uncomplicated malaria, if artemether-lumefantrine is not available or contraindicated; combined with 100 mg doxycycline or 150 mg clindamycin twice daily after 2 to 3 days (depending on the patient’s tolerance thereof) |
| Warnings/contraindications: QT abnormalities, glucose-6-phosphate dehydrogenase (G6PD) deficiency, optic neuritis, thrombocytopenia, myasthenia gravis, haemolytic uremic syndrome |
| Side effects: cinchonism; headache; nausea; auditory and visual disturbances; unusual sweating; vasodilation |
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| Chloroquine (Nivaquine® 200 mg tablets; Plasmoquine® 200 mg capsules) | Orally, 600 mg stat followed by 300 mg after 6 hours and 300 mg daily on the two following days (1.5 g over three days) | Only for the treatment of uncomplicated infections confirmed not to be P. falciparum. Oral primaquine may serve as an alternative (section 21) |
| Warnings/contraindications: psoriasis, porphyria, visual disturbances; caution advised in patients with hepatic disease, alcoholism, QT abnormalities, or G6PD deficiency |
| Side effects: cinchonism; headache; nausea; visual disturbances |
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| Artesunate (Garsun 60 mg injectable) | 2.4 mg/kg (3 mg/kg if the patient <20 kg) intravenous (IV) at 0, 12, and 24 hours followed by once daily until the patient can tolerate oral treatment | Artesunate is considered safe and tolerable and rarely leads to severe adverse events and fewer neurological defects |
| Warnings/contraindications: possible delayed haemolysis, strong UGT inducers may reduce efficacy, foetal toxicity demonstrated in animals but not confirmed teratogenicity in humans |
| Side effects: GIT disturbances, dizziness, haematological disorders very rare |
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| Quinine (IV) (Quinine Dihydrochloride-Fresenius® 300 mg/mL) | Loading: 20 mg/kg quinine dihydrochloride diluted 10 mL/kg bodyweight 5% dextrose over 5 hours Maintenance: started 8 hours after initiating loading dose; 10 mg/kg in dextrose over 4 hours; administered 8-hourly until the patient can tolerate oral treatment | Reserved for severe malaria. Never to be administered as bolus injection; intramuscular route may be used as an alternative if required (refer to guidelines); reduce dose to 10 mg/kg 12-hourly on the third day if parenteral treatment is required for longer than 48 hours |
| Warnings/contraindications: narrow therapeutic window; QT abnormalities, G6PD deficiency, optic neuritis, thrombocytopenia, myasthenia gravis, haemolytic uremic syndrome |
| Side effects: cinchonism; headache; nausea; auditory and visual disturbances; unusual sweating; vasodilation; hypoglycaemia |
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