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The Journal of the Royal Institute of Thailand Volume II - 2010 Combination Anti-malarial Therapy and WHO Recommendations 104 Artesunate plus amodiaquine This is currently available as a fixed-dose formulation and blister packs of separate scored tablets containing 50 mg of artesunate and 153 mg base of amodiaquine, respectively. A target dose of 4 mg/kg/day artesunate and 10 mg/kg/ day amodiaquine once a day for 3 days. This combination was sufficiently efficacious only where 28-day cure rates with amodiaquine monotherapy exceeded 80%. Artemether plus lumefantrine This is currently available as a fixed-dose formulation with dispersible or standard tablets containing 20 mg of artemether and 120 mg of lumefantrine. An advantage of this combination is that lumefantrine is not available as a monotherapy, and it has never been used by itself for the treatment of malaria. Lumefantrine absorption is enhanced by co-administration with fat. It is essential that patients or caregivers are informed of the need to take this ACT immediately after a meal or drink containing at least 1.2 g fat–particularly on the second and third days of treatment. The recommended treatment is a 6-dose regimen over a 3-day period. The adult dose is 4 tablets given twice a day for 3 days. This extrapolates to 1.7/12 mg/kg body weight of artemether and lumefantrine, respectively, per dose. Dihydroartemisinin plus piperaquine Dihydroartemisinin plus piperaquine is currently available as a fixed-dose combination with tablets containing 40 mg of dihydroartemisinin and 320 mg of piperaquine. A target dose of 4 mg/kg/day dihydroartemisinin and 18 mg/kg/day piperaquine once a day for 3 days, with a therapeutic dose range between 2–10 mg/ kg/day dihydroartemisinin and 16–26 mg/kg/dose piperaquine . Artesunate plus tetracycline or doxycycline or clindamycin Artesunate plus tetracycline or doxycycline or clindamycin are reserved for the very rare occasions of treatment failure with the recommended ACTs and in some special groups, e.g. pregnant women failing ACT treatment. The very recommended doses are artesunate (2 mg/kg once a day) plus tetracycline (4 mg/kg four times a day or doxycycline (3.5 mg/kg once a day) or clindamycin (10 mg/kg twice a day). Any of these combinations should be given for 7 days.