Overview of malaria treatment
Malaria is an entirely preventable and treatable disease. The primary objective of treatment is to ensure the rapid and complete elimination of the Plasmodium parasite from the patient’s blood in order to prevent progression of uncomplicated malaria to severe disease or death, and to prevent chronic infection that leads to malaria-related anaemia.
From a public health perspective, the goal of treatment is to reduce transmission of the infection to others, by reducing the infectious reservoir, and to prevent the emergence and spread of resistance to antimalarial medicines.
Importance of diagnostic testing
Patients with suspected malaria should have parasitological confirmation of diagnosis with either microscopy or rapid diagnostic test (RDT) before antimalarial treatment is started. Treatment based on clinical grounds should only be given if diagnostic testing is not immediately accessible within two hours of patients presenting for treatment. Prompt treatment – within 24 hours of fever onset – with an effective and safe antimalarial is necessary to prevent life-threatening complications.
Treatment of uncomplicated malaria
Treatment of P. falciparum infections
WHO recommends artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated malaria caused by the P. falciparum parasite. By combining two active ingredients with different mechanisms of action, ACTs are the most effective antimalarial medicines available today. WHO currently recommends five ACTs for use against P. falciparum malaria. The choice of ACT should be based on the results of therapeutic efficacy studies against local strains of P. falciparum malaria.
ACTs are the mainstay of recommended treatment for P. falciparum malaria and, as no alternative to artemisinin derivatives is expected to enter the market for at least several years, their efficacy must be preserved. WHO recommends that national malaria control programmes regularly monitor the efficacy of antimalarial medicines in use to ensure that the chosen treatments remain efficacious.
Oral monotherapy and artemisinin resistance
Artemisinin and its derivatives must not be used as oral monotherapy, as this promotes the development of artemisinin resistance. Moreover, fixed-dose formulations (combining two different active ingredients co-formulated in one tablet) are strongly preferred and recommended over co-blistered, co-packaged or loose tablet combinations, since they facilitate adherence to treatment and reduce the potential use of the individual components of co-blistered medicines as monotherapy.
Treatment of P. vivax infections
P. vivax infections should be treated with chloroquine in areas where this medicine remains effective. In areas where chloroquine-resistant P. vivax has been identified, infections should be treated with an ACT, preferably one in which the partner medicine has a long half-life.
Treatment of severe malaria
Severe malaria should be treated with injectable artesunate (intramuscular or intravenous) and followed by a complete course of an ACT as soon as the patient can take oral medicines. Where injectable treatment cannot be given, patients with severe malaria should immediately receive pre-referral treatment with intra-rectal artesunate and be referred to an appropriate facility for full parenteral treatment.
Expansion of access to ACTs
In recent years, access to ACTs has expanded substantially. By the end of 2013, ACTs had been adopted as first-line treatment policy in 79 countries. In 2013, 392 million ACT treatment courses were delivered to both the public and the private sectors in endemic countries.
Expanding case management at the community level is accelerating progress towards the goal of universal access to diagnostic testing and effective antimalarial treatment. In 2013, a total of 48 countries worldwide were implementing interventions to provide ACTs at the community level.
Last update: 25 May 2015
- Guidelines for the treatment of malaria. Third edition (2015)
- Policy brief on single-dose primaquine as a gametocytocide in Plasmodium falciparum malaria (2015)
- Severe malaria. TMIH 19, Supplement 1 (November 2014)
- Management of severe malaria – A practical handbook. Third edition (2013)
- WHO position statement: effectiveness of non-pharmaceutical forms of Artemisia annua L. against malaria (2012)
- Good procurement practices for artemisinin-based antimalarial medicines (2010)