Table 3

Recommended oral treatment for severe falciparum malaria after initial parenteral therapy for at least 24 hours when clinical improvement is evident and the patient can tolerate oral medication

Drug

Dose

Comments

Artemether/lumefantrin

80 mg arthemeter/480 mg lumefantrin once daily for 3 days

Well tolerated, faster parasite clearance, but longer fever resolution time

Atovaquone/proguanil

1000 mg atovaquone/400 mg proguanil at 0, 8, 24, 36, 48 and 60 hours

Well tolerated, more effective than mefloquine in treatment of multidrug-resistant falciparum malaria

Mefloquine

15 mg/kg (750 mg) base at 0 hours, followed by10 mg/kg (500 mg) base at 6–8 hours, and (if >60 kg) followed by 5 mg/kg (250 mg) at 16 hours

Contraindicated in persons with seizure or psychiatric disorders, or with cardiac conduction abnormalities

Quinine (sulfate salt)

10 mg salt/kg (600–650 mg) every 8 hours to complete7 days of treatment (total duration)

Side effects include cinchonism and pruritus

Trampuz et al. Critical Care 2003 7:315   doi:10.1186/cc2183