Antimalarial Treatment Guidelines

First-Line Treatment for P. vivax Malaria

• The Centers for Disease Control and Prevention recommends a total dose of 1,500 mg chloroquine base (25 mg/kg) over 3 days for adults with P. vivax malaria 1, 2, 3
• For children with P. vivax malaria, a total dose of 25 mg/kg body weight over 3 days is recommended 1, 2, 3
• Pregnant women with P. vivax malaria should use the standard adult chloroquine regimen, as chloroquine is safe during pregnancy 1, 2, 4

Primaquine for P. vivax Radical Cure

• The Centers for Disease Control and Prevention recommends 15 mg daily of primaquine for 14 days for adults with P. vivax malaria 1, 2, 3
• For children with P. vivax malaria, 0.3 mg/kg/day of primaquine for 14 days is recommended 1, 2, 3
• In populations with severe G6PD deficiency, primaquine should not be administered for more than 5 days due to the risk of life-threatening hemolysis 1, 2, 3

Monitoring and Follow-up

• The Centers for Disease Control and Prevention recommends repeat thick blood smear if symptoms persist beyond 3 days 1, 2, 4
• Alternative therapy should be instituted if parasitemia has not decreased markedly by day 3 4

Common Pitfalls

• Inadequate supervision of treatment doses can lead to treatment failure, and ideally, all doses should be directly observed over the treatment period 4
• Other causes of fever, such as pneumonia, meningitis, or acute respiratory infections, should be considered in patients with Plasmodium on blood smear 2, 4