Page 156 - PJ MED OPS Handbook 8th Ed

Dosage of atovaquone/proguanil in treatment of malaria in pediatric patients
Weight (kg) Total daily dose Dosage regimen
5 to 8 125mg/50mg 2 tablets (pediatric strength) daily for 3 consecutive days
9 to 10 187.5mg/75mg 3 tablets (pediatric strength) daily for 3 consecutive days
11 to 20 250mg/100mg 1 tablet (adult strength) daily for 3 consecutive days
21 to 30 500mg/200mg 2 tablets (adult strength) as single daily
31 to 40 750mg/300mg 3 tablets (adult strength) as single daily dose for
3 consecutive days
>40 1g/400mg 4 tablets (adult strength) as single daily dose for
3 consecutive days

Contraindications: hypersensitivity to atovaquone, proguanil, prophylaxis in patients with
severe renal impairment (CrCl <30mL/min) unless potential benefits outweigh risks of non-
treatment (proguanil accumulates in severe renal failure)
• Side-effects: headache, abdominal pain, nausea/vomiting/diarrhea, dizziness, cough (pediatrics)
• Adverse reactions: liver transaminase elevations, possible association with seizures and psy-
chotic events (e.g., hallucinations), cutaneous reactions, including photosensitivity, erythema
multiforme and Stevens-Johnson syndrome
• Other notes:
○ Take daily dose at the same time every day with food or milk
○ If vomiting occurs within 1 hour of dosing, repeat the dose
○ Treatment has not been evaluated for treatment of cerebral malaria or other severe man-
ifestations of complicated malaria
○ Absorption may be reduced in patients with diarrhea or vomiting. May need to add anti-
emetic to prevent vomiting.
○ Include protective clothing, insect repellants, bed nets as important components of ma-
laria prophylaxis
○ If a dose is skipped, take it as soon as possible, and then return to normal schedule. Do
not double the next dose.

Atropine Sulfate
GROUNDING medication for personnel on flight status
• Description: vagolytic
• Indications: symptomatic bradycardia; initial therapy for patients with symptomatic brady-
cardia; Nerve Agent Antidote (positive SLUDGE signs/symptoms post chemical attack)
• Adult dose:
○ Bradycardia: 0.5–1.0mg IV q5min until desired response is achieved; 3mg max
○ Nerve Agent: mild symptoms – 2mg IM, repeat as needed q10min
Severe Symptoms – 6mg IM initial dose, repeat doses of 2mg q5min during resuscitation
for max of 20mg
• Pediatric dose: 0.015mg/kg up to a max dose of 0.04mg/kg

154 n Pararescue Medical Operations Handbook / 8th Edition