Recommendations for Parasitological diagnosis:
| Recommendation | Level of Evidence |
| In areas of low to moderate transmission, prompt parasitological confirmation of the diagnosis is recommended before treatment is started. |
E |
| In areas of high stable malaria transmission, children under 5 years should be treated on the basis of clinical diagnosis. In older children and adults including pregnant females, a parasitological diagnosis is recommended before treatment is started |
E |
| In all suspected cases of severe malaria, a parasitological confirmation of the diagnosis of malaria is recommended. In absence or delay in diagnosis, patients should be treated on clinical grounds. |
E |
Treatment of Uncomplicated P. Falciparum Malaria:
To counter the threat of resistance of P. Falciparum to monotherapies, and to improve treatment outcome, combination of antimalarials are now recommended.
| Recommendation | Level of evidence |
| The treatment of choice for uncomplicated falciparum malaria is a combination of two or more antimalarials with different mechanisms of action | S, T, O |
| Artemisinin-based combination therapies (ACTs) are the recommended treatments for uncomplicated falciparum malaria | S |
The following ACTs are currently recommended:
Artemether+Lumefantrine, Artesunate+Amodiaquine, Artesunate+Mefloquine, Artesunate+Sulfadoxine-pyrimethamine | S, T, O |
The choice of ACT in a country or region will be based on the level of resistance of the partner medicine in the combination:
- in areas of multidrug resistance (SouthEast Asia), Artesunate+Mefloquine or Artemether+Lumefantrine
- in Africa, Artemether+Lumefantrine, Artesunate+Amodiaquine, |
E
S |
| The artemisinin derivative components of the combination must be given for at least 3 days for an optimum effect | S |
| Artemether+Lumefantrine ahould be used with a 6-dose regimen | T, E |
| Amodiaquine+Sulfadoxine-Pyrimethamine may be considered as an interim option where ACTs cannot be made available | E |
If malaria is suspected and the decision to treat is made, then a full effective treatment is required, whether or not the diagnosis is confirmed by a test.
Recommendations on treatment approaches that should be avoided:
| Recommendation | Level of evidence |
| Partial treatment should not be given even when the patients are considered to be semi-immune or the diagnosis is uncertain. | E |
| The Artemisinin and the partner medicines of ACTs should not be available as monotherapies | E
|
Recommendation for Treatment Failure Management:
Failure within 14 days:
- Must be confirmed Parasitologically
- Should be treated with second line drugs
Failure after 14 days:
- Can be treated with the first line ACTs, except when initially treated with Mefloquine.
- Parasitological confirmation is desirable, but not a pre-condition.
Recommended Second-line antimalarial treatments:
- Alternative ACT known to be effective in the region
- Artesunate + Doxycycline/ Tetracycline/ Clindamycin
- Quinine + Doxycycline/ Tetracycline/ Clindamycin
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