Chloroquine Treatment Regimens and Management

Treatment Regimens for Uncomplicated Malaria

The Centers for Disease Control and Prevention recommends a total dose of 1,500 mg chloroquine base (approximately 25 mg/kg body weight) administered over 3 days as 600 mg, 600 mg, and 300 mg at 0, 24, and 48 hours, respectively, for adults with uncomplicated malaria 1
For children with uncomplicated malaria, the Centers for Disease Control and Prevention recommends a total dose of 25 mg/kg body weight chloroquine administered over 3 days as 10 mg/kg, 10 mg/kg, and 5 mg/kg at 0, 24, and 48 hours, respectively 1
Pregnant women with uncomplicated malaria can follow the same regimen as adults, as chloroquine is considered safe during pregnancy 1

Supplementation with primaquine is necessary for radical cure of P. vivax and P. ovale infections, with adults requiring 15 mg daily for 14 days and children requiring 0.3 mg/kg/day for 14 days 2
G6PD testing is mandatory before primaquine administration to prevent hemolytic reactions, especially in populations with high prevalence of G6PD deficiency 2

In areas with chloroquine resistance, alternative treatments such as sulfa drugs with pyrimethamine, tetracycline, quinine, or newer drugs like mefloquine should be considered, with artemisinin-based combination therapy (ACT) recommended for chloroquine-resistant areas 1
If symptoms persist after 48-72 hours of chloroquine treatment, second-line drugs should be administered 1

For expatriates in endemic areas, weekly chloroquine (300 mg base) during exposure and for 6 weeks after leaving the area is recommended for malaria prophylaxis 5
During high transmission seasons, chemoprophylaxis should be considered for high-risk groups, including children under 5 years, pregnant women, and individuals with compromised health status 4

The first dose of chloroquine should be administered when blood smear is taken, with patients returning the next day for smear results and continuing treatment if positive 3
If symptoms persist beyond 3 days, repeat blood smear and consider alternative therapy if parasitemia has not markedly diminished 3
Monitor for clinical improvement within 48 hours and confirm parasite clearance with follow-up blood smears 2

Minor side effects of chloroquine may include gastrointestinal disturbance, headache, dizziness, blurred vision, and pruritus, while serious side effects are rare with prophylactic doses 6
Chloroquine may exacerbate psoriasis and interfere with antibody response to intradermal rabies vaccine 6

For severe malaria, intravenous artesunate is the first-line treatment, according to the World Health Organization 2