Malaria: Falciparum

Key points

• TREATMENT OF SEVERE OR COMPLICATED FALCIPARUM MALARIA: INTRAVENOUS ARTESUNATE is the treatment of choice in adults and children (Grade 1A). If artesunate is not immediately available, start INTRAVENOUS QUININE at once rather than waiting (Grade 1A) — quinine requires careful monitoring for HYPOGLYCAEMIA.
• Severe falciparum malaria, or infection with a parasite count above 2% of red cells parasitized, should be treated INTRAVENOUSLY until the patient is well enough to switch to oral therapy. Severe disease is a rare complication of P. vivax and P. knowlesi but also needs parenteral treatment; artesunate is highly effective in severe P. knowlesi.
• UNCOMPLICATED falciparum malaria: an oral ACT is first-line · alternatives are quinine with doxycycline or clindamycin, or atovaquone-proguanil · doxycycline must NOT be given to children under 12.
• Feature of severe malaria
• schizonts on a blood film
• parasitaemia > 2%
• hypoglycaemia
• temperature > 39 °C