Treatment Guidelines for P. vivax Malaria

First-Line Treatment

Chloroquine phosphate is administered at a total dose of 25 mg base/kg over 3 days for uncomplicated P. vivax malaria in India, with dosing based on G6PD status, as recommended by the World Health Organization 1

Primaquine must be administered to eliminate liver hypnozoites and prevent relapses in patients with uncomplicated P. vivax malaria, with a dosage of 30 mg base per day for 14 days for G6PD normal patients, as recommended by the Centers for Disease Control and Prevention 2
G6PD testing is mandatory before primaquine administration to determine the appropriate dosage and prevent hemolysis, as recommended by the American Society of Tropical Medicine and Hygiene 2

Artemisinin-based combination therapy (ACT) is considered for patients from known chloroquine-resistant areas, with dihydroartemisinin-piperaquine (DHA-PPQ) preferred due to its longer half-life, as recommended by the World Health Organization 1, 3

Intravenous artesunate is the first-line treatment for severe malaria, with a dosage of 2.4 mg/kg IV at 0, 12, and 24 hours, then daily for up to 7 days, as recommended by the World Health Organization 1, 4
If artesunate is unavailable, quinine dihydrochloride is the second-line option, with a loading dose of 20 mg salt/kg over 4 hours, as recommended by the Centers for Disease Control and Prevention 4

Monitor for clinical improvement within 48 hours of starting treatment, and follow-up blood smears should be obtained to confirm parasite clearance, as recommended by the World Health Organization 1
For patients on primaquine, monitor for signs of hemolysis, such as dark urine, jaundice, and fatigue, as recommended by the American Society of Tropical Medicine and Hygiene 2