QUESTION
My husband weighs and has malaria. He was told by the pharmacist to take 2 tablets stat, then 1 daily for five days followed by 3 Fansidar tablets. We live in Papua New Guinea. I see on the Duo-Cotecxin web site the dose is three tabs daily. Which is correct?
ANSWER
Fansidar is a very different drug to Duo-Cotecxin—it is made of a combination of sulfadoxine and pyrimethamine, whereas Duo-Cotecxin is an artemisisin-based combination therapy (ACT), consisting of dihydroartemisinin together with piperaquine. As such, the dosages and time courses of therapy are likely to be different. However, Fansidar is not usually recommended as treatment anymore—it appears to have low efficacy against Plasmodium vivax and in the 1980s and 1990s, the World Health Organisation and Center for Disease Control (CDC in the US) only recommended it for use against chloroquine-resistant P. falciparum.
However, nowadays, both organisations recommend ACTs (like Duo-Cotexcin) to treat all uncomplicated P. falciparum infection as well. Therefore, unless your husband has been diagnosed with P. ovale or P. malariae malaria (both of which are sometimes found in PNG), Fansidar probably should not have been the first-line treatment given to him. Keep a close watch over his recovery, and if there is any sign of reccurrence of the symptoms, go back to the doctor for another malaria test.
WHAT IS THE DOSEAGE FOR COTECXIN FOR MALARIA
Cotecxin by itself just contains dihydroartemisinin, without a secondary anti-malarial compound, and as such is not recommended by the World Health Organization for the treatment of malaria. Rather, they recommend artemisinin-based combination therapies (ACTs) which combine an artemisinin derivative with a secondary compounds. In the case of dihydroartemisinin, the result was a combination with piperaquine, which is marketed as Artekin (40mg per tablet of dihydroartemisinin) or Duo-Cotecxin (60mg per table of dihydroartemisinin). The adult dose is 1.2mg per kg of body weight (or to the nearest half tablet), with doses at 0hrs, 8 hrs, 24hrs and 48hrs, or the same total dose can be taken once a day for three consecutive days.
I was told to take 3 Duo-Cotecxin tabs all at once. Am I safe? Is that right?
It depends on the size of the tablet and your weight – the usual adult first dose is 1.6 mg/kg, so check what mg is contained in each of your pills, and do the math based on your weight to see how many of them you should take (and round up if necessary).