Clinical Pathways
Clinical Pathways
Severe Malaria
Severe Malaria

Severe Malaria

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Action

Severe malaria and/or patient unable to tolerate oral medication, regardless of species*

  • Admit to ICU
  • Call CDC
  • Administer IV artesunate (call CDC)
  • Start interim treatment:
    • Artemether-lumefantrine

      • or

    • Atovaquone-proguanil

      • or

    • Quinine

      • or if no other options

    • Mefloquine
  • Monitor parasitemia every 12-24 hours
  • Administer follow-on treatment after artesunate complete*
    • Artemether-lumefantrine

      • or

    • Atovaquone-proguanil

      • or

    • Doxycycline (or clindamycin)

      • or if no other options

    • Mefloquine

Background

*If species later identified as P vivax or P ovale, add primaquine or tafenoquine if not G6PD deficient by quantitative testing.

Treatment of severe malaria is with intravenous (IV) artesunate. If not available locally, it should be requested from the CDC and an oral antimalarial should be started. Once the patient’s parasitemia is ≤1%, a course of a follow-on regimen should be administered.  Patients with severe malaria should be admitted to an intensive care unit, where parasitemia should be monitored as an indicator of treatment response.  Exchange transfusion for severe malaria is no longer recommended.  In general, hospitalization for monitoring should be considered for young children and those with parasitemia >4%, even if the patient is well appearing.

Standard precautions are recommended. Patients should be advised to protect themselves against mosquito bites in the first week of illness (when viremia is highest) to prevent transmission to others.

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References
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