Anti-Malarial Drugs Used in Pediatrics

Anti-Malarial Drugs Classification Chloroquine Artemether-Lumefantrine Atovaquone-Proguanil Mefloquine Quinine Primaquine Doxycycline

Classification of Anti-Malarial Drugs

1. 4-Aminoquinolines: Chloroquine

2. Artemisinin-Based Combination Therapies (ACTs): Artemether-Lumefantrine

3. Hydroxynaphthoquinones: Atovaquone-Proguanil

4. Quinoline Methanols: Mefloquine

5. Cinchona Alkaloids: Quinine

6. 8-Aminoquinolines: Primaquine

7. Tetracyclines: Doxycycline

Chloroquine

Indications: Treatment and prophylaxis of malaria, especially caused by Plasmodium vivax, P. ovale, and P. malariae.

Dosage:

• Prophylaxis: 5 mg/kg (max 300 mg) once weekly.
• Treatment: 10 mg/kg (max 600 mg) on day 1, then 5 mg/kg (max 300 mg) on days 2 and 3.

Contraindications: Hypersensitivity to chloroquine or other 4-aminoquinolines.

Adverse Effects: Gastrointestinal disturbances, headache, pruritus, visual disturbances.

Special Note: Not effective against chloroquine-resistant strains of Plasmodium falciparum.

Artemether-Lumefantrine

Indications: Treatment of uncomplicated malaria caused by Plasmodium falciparum.

Dosage:

• 5-14 kg: 1 tablet (20 mg artemether/120 mg lumefantrine) twice daily for 3 days.
• 15-24 kg: 2 tablets twice daily for 3 days.
• 25-34 kg: 3 tablets twice daily for 3 days.
• 35 kg and above: 4 tablets twice daily for 3 days.

Contraindications: Hypersensitivity to artemether or lumefantrine.

Adverse Effects: Headache, dizziness, anorexia, sleep disturbances.

Special Note: Should be taken with food or milk to enhance absorption.

Atovaquone-Proguanil

Indications: Prophylaxis and treatment of malaria caused by Plasmodium falciparum.

Dosage:

• Prophylaxis:
  • 11-20 kg: 1 pediatric tablet (62.5 mg atovaquone/25 mg proguanil) daily.
  • 21-30 kg: 2 pediatric tablets daily.
  • 31-40 kg: 3 pediatric tablets daily.
  • Above 40 kg: 1 adult tablet (250 mg atovaquone/100 mg proguanil) daily.
• Treatment:
  • 5-8 kg: 2 pediatric tablets daily for 3 days.
  • 9-10 kg: 3 pediatric tablets daily for 3 days.
  • 11-20 kg: 1 adult tablet daily for 3 days.
  • 21-30 kg: 2 adult tablets daily for 3 days.
  • 31-40 kg: 3 adult tablets daily for 3 days.
  • Above 40 kg: 4 adult tablets daily for 3 days.

Contraindications: Severe renal impairment, hypersensitivity to atovaquone or proguanil.

Adverse Effects: Abdominal pain, nausea, vomiting, headache.

Special Note: Should be taken with food or a milky drink for better absorption.

Mefloquine

Indications: Prophylaxis and treatment of malaria, particularly in areas with chloroquine-resistant Plasmodium falciparum.

Dosage:

• Prophylaxis:
  • 5-15 kg: 62.5 mg once weekly.
  • 16-30 kg: 125 mg once weekly.
  • 31-45 kg: 187.5 mg once weekly.
  • Above 45 kg: 250 mg once weekly.
• Treatment:
  • 20-25 mg/kg as a single dose or divided into two doses 6-8 hours apart.

Contraindications: Hypersensitivity to mefloquine, history of seizures, severe psychiatric disorders.

Adverse Effects: Nausea, dizziness, neuropsychiatric effects, sleep disturbances.

Special Note: Neuropsychiatric side effects may be severe; not recommended for those with a history of psychiatric disorders.

Quinine

Indications: Treatment of severe or complicated malaria.

Dosage:

• 10 mg/kg every 8 hours for 7 days (oral).
• Loading dose: 20 mg/kg, followed by 10 mg/kg every 8 hours (IV).

Contraindications: Hypersensitivity to quinine or quinidine, G6PD deficiency, tinnitus, optic neuritis.

Adverse Effects: Cinchonism (tinnitus, headache, nausea), hypoglycemia, cardiac arrhythmias.

Special Note: Monitor blood glucose levels and cardiac function during treatment.

Primaquine

Indications: Radical cure of P. vivax and P. ovale malaria (to eradicate liver hypnozoites).

Dosage:

• 0.5 mg/kg daily for 14 days.

Contraindications: G6PD deficiency, pregnancy, hypersensitivity to primaquine.

Adverse Effects: Hemolysis in G6PD-deficient individuals, gastrointestinal disturbances, methemoglobinemia.

Special Note: G6PD deficiency must be ruled out before administration.

Doxycycline

Indications: Prophylaxis and treatment of malaria (used in combination with other antimalarials for treatment).

Dosage:

• Prophylaxis: 2 mg/kg (up to 100 mg) once daily.
• Treatment: 100 mg twice daily for 7 days (in combination with quinine or artesunate).

Contraindications: Hypersensitivity to tetracyclines, children under 8 years of age, pregnancy.

Adverse Effects: Photosensitivity, gastrointestinal disturbances, esophagitis.

Special Note: Avoid in children under 8 due to risk of tooth discoloration; ensure adequate fluid intake to prevent esophagitis.