TABLE 2: TREATMENT OF SEVERE  PLASMODIUM INFECTIONS
RECOMMENDED DRUG	ADULTS AND CHILDREN - DOSE AND DURATION
Quinine (Intravenous) (e.g. Adco-quinine dihydrochloride®)	(1ml = 300 mg quinine salt) Loading dose Quinine dihydrochloride salt 20 mg/kg body weight, intravenously, in 5 % dextrose saline (5-10 ml/kg body weight depending on the patients fluid balance) over 4 hours. Maintanance dose 8 hours after start of the loading dose, give a maintenance dose quinine dihydrochloride salt of 10 mg/kg in dextrose saline diluted as above over 4 hours. The maintanance dose should be repeated every 8 hours until the patient can take oral medication. Total duration of treatment: 7 days, or until smears are negative.
RECOMMENDED DRUG	DOSE AND DURATION
	ADULTS	CHILDREN
Quinine (oral) (e.g. Quinine Sulphate®)	(1 tablet = 300 mg quinine) 600 mg (2 tablets) 8 hourly for 7 days.	10 mg/kg body weight 8 hourly for 7 days.
		Age (year)		Weight (kg)		Dosage
		<2		<15		¼ tablet
		2-4		15-19		½ tablet
		5-8		20-30		1 tablet
		9-15		31-45		1½ tablets
		>15		>45		Adult dose
Doxycycline (oral) (only in combination with quinine when necessary) (e.g. Bok-c-lin®, Cyclidox®, Doxycyclin®, Doxylets®, Doxymycin®, Dumoxin®, Theodox®, Viacin®, Vibramycin®)	(1 tablet = 100mg doxycycline) (1 capsule = 50mg, 100 mg or 200 mg doxycycline) 200 mg stat and then 100 mg daily for 7 days or until blood smear is negative.	Contra-indicated in children under 8 years. 4 mg/kg body weight stat and then 2 mg/kg daily for 7 days.
		Age (year)	Weight(kg)		Dosage
		8-15	31-45		Depending on strength of tablet
		>15	> 45		Adult dose
Sulfadoxine-pyrimethamin e (oral) (only in combination with quinine when necessary) (e.g. Fansidar®)	(1 tablet = 500 mg sulfadoxine + 25 mg pyrimethamine) 3 tablets stat as a single dose.	Contra-indicated in children under 1 year. One dose stat.
		Age (year)		Weight (kg)		Dosage
		1-4		10-19		1 tablet
		5-8		20-30		1½ tablets
		9-15		31-45		2 tablets
		>15		> 45		Adult dose

Halofantrine (oral) (e.g. Halfan®)	(1 tablet = 250 mg halofantrine hydrochloride) 500 mg (2 tablets) 6 hourly for 3 doses on an empty stomach. Repeat treatment dosing 1 week later in non-immune patients.	Contra-indicated for infants under 1 year. 3 doses of 8 mg/kg body weight at 6 hourly intervals.
		Weight (kg)	Dosage
		26-31	1 tablet
		32-40	1½ tablets
		> 40	Adult dose
		A suspension is available for children. (100 mg halofantrine = 5 ml) 3 doses of 8mg/kg body weight at 6 hourly intervals.
		Weight (kg)	Dosage
		10-12	5 ml
		13-18	7,5 ml
		19-25	10 ml
		26-31	12,5 ml
		32-40	15 ml
		>40	Adult dose

The guidelines are endorsed by the Medical Association of South Africa.