Treatment

Check for criteria for severe malaria.

Treat severe malaria immediately with IV artesunate.

Treat uncomplicated malaria based on species, resistance patterns, and degree of chemoprophylaxis.

Report all confirmed malaria to public health authorities.

Start IV artesunate

Repeat malaria parasite density after 3rd dose of artesunate.

• > 1%: Continue IV artesunate

• ≤ 1%: Switch to oral antimalarials

  • Artemether-lumefantrine (preferred)

  • OR atovaquone-proguanil

  • OR quinidine (in the US; quinine elsewhere)

Supportive care and monitoring

• Manage fever.

• Prevent hypoglycemia.

Disposition: Admit to ICU.

Agent selection based on:

• Infecting Plasmodium species

• Prior use of chemoprophylaxis

• Likelihood of chloroquine-resistance

• See “Overview of treatment of uncomplicated malaria.”

Additional considerations in P. vivax and P. ovale

• Check G6PD activity levels.

• Give primaquine or tafenoquine to eradicate hypnozoites dormant in hepatocytes.