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falciparam malaria treatment

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falciparum malaria treatment

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WHO guidelines treatment Plasmodium falciparum malaria uncomplicated severe artesunate 2025

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Falciparum malaria requires prompt treatment. The correct regimen depends on whether it is uncomplicated or severe/complicated, local resistance patterns, age, pregnancy, and ability to take oral medication.

1. Uncomplicated P. falciparum malaria

Treat with a 3-day artemisinin-based combination therapy (ACT). Do not use oral artemisinin alone.
WHO-recommended ACT options include:
  • Artemether-lumefantrine
  • Artesunate-amodiaquine
  • Artesunate-mefloquine
  • Dihydroartemisinin-piperaquine
  • Artesunate-sulfadoxine-pyrimethamine, only where the partner drug remains effective
  • Artesunate-pyronaridine
The exact choice and dose must follow the national malaria programme and local resistance data. WHO recommends ACT for adults and children, including infants and women in the second and third trimesters of pregnancy. Treatment is typically for 3 days. WHO malaria guideline
Do not use chloroquine for falciparum malaria unless local testing confirms chloroquine-sensitive infection, because resistance is widespread.
  • Goldman-Cecil Medicine, p. 1035

2. Severe or complicated falciparum malaria

This is a medical emergency requiring hospital admission.
Use IV artesunate immediately. WHO recommends IV or IM artesunate for at least 24 hours and until the person can take oral medicine, then complete treatment with a full 3-day ACT. Standard dosing is:
  • Adults and children ≥20 kg: artesunate 2.4 mg/kg IV/IM at 0, 12, and 24 hours, then once daily if needed.
  • Children <20 kg: 3 mg/kg IV/IM per dose.
Once oral medication is tolerated, complete a 3-day ACT course. IV artesunate is preferred over quinine and has better outcomes in severe malaria. Monitor for hypoglycaemia, anaemia, renal failure, acidosis, seizures, shock, pulmonary oedema, and delayed post-artesunate haemolysis.

Emergency warning signs

Go to an emergency department now if there is confusion, drowsiness/coma, repeated vomiting, inability to drink or take tablets, seizures, breathing difficulty, jaundice, dark urine, bleeding, shock, very low urine output, or pregnancy with suspected malaria.
A blood smear or rapid diagnostic test should be done urgently, but treatment should not be delayed in suspected severe malaria. Recent evidence continues to support ACTs for uncomplicated disease, including artemether-lumefantrine and artesunate-pyronaridine (PMIDs: 42174576, 41085194).
If you tell me the country, age/weight, pregnancy status, and whether there are danger signs, I can explain the guideline-based regimen more specifically.
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