Non-Severe, Uncomplicated

Clinical Description

Refer to the MOH National Malaria Control Program Revised Guidelines for the Treatment of Malaria in Malawi, 5th edition, 2020, for full details of malaria management

Signs and Symptoms

• Fever or recent history of fever in pregnant women or children under the age of five years and fever or history of fever plus one other symptom or sign suggestive of malaria in over five children and adults

Investigations

• All suspected uncomplicated malaria cases at all levels of the health care delivery system should be tested using malaria rapid diagnostic tests (mRDTs) or by microscopic examination of blood film wherever possible
• Testing (film or mRDT)
• Repeat diagnostic test (film or mRDT) if:
• the first test was positive and there is persistent fever or worsening condition despite suitable antimalarial treatment

Treatment

• The first test was negative and antimalarial treatment was not given, but the patient's fever persists or conditiondeteriorates
• In the event that both mRDT and microscopy are not available, REFER TO THE

FACILITY WHERE THE TESTS CAN BE DONE: BUT IF SUSPECTING SEVERE MALARIA, GIVE PRE-REFERAL TREATMENT, INJECTABLE ARTESUNATE. Don’t treat on the basis of presumptive diagnosis

First-Line Treatment

• Give Lumefantrine 120mg/Artemether 20mg
• (LA) even to pregnant women in 1st trimester
• Lumefantrine-artemether comes in two orals
• formulations:
• Non-dispersible LA [LA(ND)] for older children weighing 20kgs or more including adults and
• Dispersible LA [LA(D)] for children weighing less than 20kg

Note: If LA(D) is not available, LA(ND) can be used to treat children weighing less than 25kg

Dosage Schedule for dispersible (D) and non- dispersible (ND) Lumefantrine-Artemether (LA- 120mg/20mg tablets).

Body weight in Kg (age in years)

No. of tablets at approximate timing of dosing

Day 1 Day 2 Day 3

Start dose After 8 hrs

AM PM AM PM

LA(D) ≤14.9 kg (<3) 1 1 1 1 1 1

LA(D) 15-24.9kg (>3- 8) 2 2 2 2 2 2

LA(ND) 25-34.9kg (>9-14) 3 3 3 3 3 3

LA(ND) ≥35 kg (>14) 4 4 4 4 4 4

• First dose should be given as DOT. If vomiting occurs within 30 minutes, repeat the dose
• Dose is given according to body weight
• If possible, each dose should be taken with milk, which improves the absorption of lumefantrine component of the combination
• If fever persists beyond 72 hours, do malaria microscopy, and if the result is positive, give second line treatment in patients with contractions or intolerance to

LA give second line treatment.

Second-Line Treatment

Give Artesunate 4 mg/kg/day and Amodiaquine 10 mg/kg/day 24 hourly for 3 days

Dosage schedule for fixed combination dose of artesunate-amodiaquine

Body Weight

• (kg) Age

Daily dose for 3 days artesunate- amodiaquine

Preparation strength per tablet 5.0- 8.9 2-11 months 1 tablet 25 mg/67.5 mg 9.0-17.9 1-5years 1 tablet 50mg/135mg 18.0-35.9 6-13 years 1 tablet 100 mg/270 mg >36 14 years old and above 2 tablets 100mg/270mg

Note:

• Treatment failure to first line treatment (LA) should be suspected if symptoms persist or the patient clinically deteriorates three to 14 days after initiation of LA drug therapy
• Side effects: Transient rise in transaminases and transient reduction in white blood cell count. The dosing schedule is indicated in Table 1.4 below