What is the simple, easy-to-understand systemic treatment for uncomplicated and severe malaria?

Malaria Treatment: Simple, Systematic Guide

For uncomplicated malaria, give artemether-lumefantrine (4 tablets at hour 0,4 tablets at hour 8, then 4 tablets twice daily on days 2-3) with a fatty meal; for severe malaria, give intravenous artesunate immediately (2.4 mg/kg at 0,12, and 24 hours, then daily). 1

Step 1: Determine Disease Severity

Check for any of these danger signs that mean severe malaria: 1

• Confusion or unconsciousness
• Difficulty breathing or shock
• Seizures (fits)
• Yellow eyes with organ problems
• Very low blood sugar
• Kidney failure (creatinine >3 mg/dL)
• Severe anemia (hemoglobin <7 g/dL)
• Parasites in >4-5% of red blood cells

If ANY danger sign is present, this is severe malaria requiring immediate IV treatment. 1

Step 2: Treatment for Uncomplicated Malaria

First Choice: Artemether-Lumefantrine 1

Dosing (for adults and children >35 kg): 1

• Hour 0: Take 4 tablets
• Hour 8: Take 4 tablets
• Day 2: Take 4 tablets in morning, 4 tablets in evening
• Day 3: Take 4 tablets in morning, 4 tablets in evening

Critical rule: MUST take every dose with fatty food or fatty drink (milk, yogurt, peanut butter). Without fat, the medicine doesn't work properly and treatment fails. 1

Safe for pregnant women in all trimesters. 1

Second Choice: Dihydroartemisinin-Piperaquine 1

Dosing (for adults 36-75 kg): 1

• Take 3 tablets once daily for 3 days
• For adults >75 kg: Take 4 tablets once daily for 3 days

Critical rule: Take on EMPTY stomach (no food). This is opposite of artemether-lumefantrine. 1

Better at preventing malaria from coming back compared to artemether-lumefantrine. 1

When NOT to Use These Medicines 1

Avoid both artemether-lumefantrine and dihydroartemisinin-piperaquine if: 1

• Patient has heart rhythm problems (prolonged QTc)
• Patient takes other medicines that affect heart rhythm

In these cases, use atovaquone-proguanil instead: 4 tablets daily for 3 days with fatty food. 1

Step 3: Treatment for Severe Malaria

Give intravenous artesunate immediately—this is a medical emergency: 1

Dosing: 1

• 2.4 mg/kg IV at hour 0
• 2.4 mg/kg IV at hour 12
• 2.4 mg/kg IV at hour 24
• Then 2.4 mg/kg IV once daily until parasites drop below 1% and patient can swallow

Once patient improves and can take pills, complete treatment with full course of artemether-lumefantrine or dihydroartemisinin-piperaquine. 1

Patient needs intensive care monitoring for: 1

• Breathing problems
• Shock
• Kidney failure
• Low blood sugar
• Seizures
• Severe infections

Step 4: Special Situations

Pregnant Women 1

• Uncomplicated malaria: Use artemether-lumefantrine in all trimesters (safe, no birth defects)
• Severe malaria: Use IV artesunate immediately, regardless of trimester

Children 1

• Use same medicines as adults, adjusted for weight
• For children >35 kg: Use adult doses
• For severe malaria in children: Also give antibiotics until bacterial infection ruled out

Non-Falciparum Malaria (P. vivax, P. ovale, P. malariae) 2

First, treat the blood infection: 2

• In areas without chloroquine resistance: Give chloroquine (600 mg, then 600 mg at 24 hours, then 300 mg at 48 hours)
• In areas with chloroquine resistance: Use artemether-lumefantrine or dihydroartemisinin-piperaquine

Then, prevent relapse (for P. vivax and P. ovale only): 2

• Give primaquine 30 mg daily for 14 days
• MUST test for G6PD deficiency BEFORE giving primaquine—can cause severe blood breakdown if deficient
• Never give primaquine to pregnant women

Step 5: Follow-Up Monitoring

After IV artesunate treatment, check blood counts at days 7,14,21, and 28 because delayed anemia occurs in 10-15% of patients. 3

Common Mistakes to Avoid

Most important mistake: Not giving artemether-lumefantrine with fatty food—this causes treatment failure. 1

Second mistake: Confusing the food requirements—artemether-lumefantrine needs fat, dihydroartemisinin-piperaquine needs empty stomach. 1

Third mistake: Delaying IV artesunate in severe malaria—every hour of delay increases death risk. 1

Fourth mistake: Giving primaquine without checking G6PD status—can cause life-threatening blood breakdown. 2

Fifth mistake: Not admitting patients with uncomplicated malaria for at least 24 hours observation—patients can deteriorate suddenly. 4