Treatment of Uncomplicated Malaria in Tanzania

First-Line Treatment Options

The World Health Organization recommends artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DP) as first-line treatment for uncomplicated Plasmodium falciparum malaria in Tanzania 1
Dosing for patients with AL is 4 tablets at 0 hours, 4 tablets at 8 hours on day 1, then 4 tablets twice daily on days 2 and 3, and must be taken with a fatty meal or drink to enhance absorption 1, 2, 3
AL provides rapid parasite clearance, but common adverse effects include headache, vertigo, digestive disorders, and potential QTc interval prolongation 1, 4
Dihydroartemisinin-piperaquine (DP) dosing is 3 tablets daily for 3 days (36-75 kg) or 4 tablets daily for 3 days (>75 kg), and must be taken in fasting condition 1, 2
DP has similar efficacy to AL, but may offer better protection against reinfection, and common adverse effects include headache, vertigo, digestive disorders, and QTc interval prolongation 1

Both AL and DP demonstrate high efficacy for uncomplicated falciparum malaria in Tanzania, but patients at risk of QTc prolongation or taking medications that prolong QTc should avoid both medications 1, 4
AL can be used in all trimesters of pregnancy as indicated by the World Health Organization and the Centers for Disease Control and Prevention 1

Atovaquone-Proguanil is recommended as second-line treatment when ACTs are contraindicated, with dosing of 4 tablets daily for 3 days (>40 kg), and must be taken with a fatty meal or drink 1
Quinine sulfate plus doxycycline or clindamycin is considered a third-line option, with quinine dosing of 3 tablets (750 mg salt) for 3-7 days plus doxycycline 100 mg twice daily for 7 days 1, 3, 5

Monitor for post-artemisinin delayed hemolysis (PADH), particularly at days 7, 14, 21, and 28 after treatment, and check for QTc prolongation in patients receiving AL or DP 1, 6, 7

In cases of severe malaria, intravenous artesunate is the first-line treatment, and for P. vivax or P. ovale infections, treatment with ACTs or chloroquine followed by primaquine is needed to prevent relapse from liver hypnozoites 6, 7
Test for G6PD deficiency before administering primaquine 6

Failure to ensure adequate fat intake with AL administration can result in subtherapeutic drug levels and treatment failure, and failing to recognize signs of severe malaria requiring parenteral therapy can lead to poor outcomes 6, 7