Malaria infection Management Severity grading Q Does the patient have prostration/impaired consciousness? Q Does the patient have multiple convulsions? Q Does the patient have respiratory distress? Q Does the patient have pulmonary edema? Q Does the patient have circulatory collapse? Q Does the patient have abnormal bleeding? Q Does the patient have jaundice? Q Does the patient have Hgburia? No to all Management of uncomplicated P. falciparum malaria Q Does the patient have P. falciparum malaria? Yes Administer any of the following artemisinin-based combination therapies for 3 days for the treatment of adult patients with uncomplicated P. falciparum malaria: artemether-lumefantrine artesunate-amodiaquine artesunate-mefloquine dihydroartemisinin-piperaquine artesunate plus sulfadoxine-pyrimethamine artesunate-pyronaridine. A Administer a single dose of 0.25 mg/kg body weight primaquine with artemisinin-based combination therapy in patients with P. falciparum malaria (except pregnant patients and patients breastfeeding infants aged < 6 months) to reduce transmission in low- transmission areas. Do not obtain G6PD testing. B Obtain close monitoring in patients with P. falciparum hyperparasitemia, in addition to artemisinin-based combination therapy, as they are at increased risk for treatment failure, severe malaria, and death. A No Management of uncomplicated P. vivax, P. ovale, P. malariae, or P. knowlesi malaria Q Is the patient a pregnant woman or a child < 6 months of age? Q Is the patient breastfeeding an infant < 6 months of age, or an older infant in whom glucose-6 phosphate dehydrogenase status is unknown? Q Does the patient have G6PD deficiency? No to all Continue management and follow-up as clinically appropriate. Yes to any Treat patients with malaria as uncomplicated if the malaria species is not known with certainty. A Administer either artemisinin-based combination therapy or chloroquine in adult patients with uncomplicated P. vivax, P. ovale, P. malariae, or P. knowlesi malaria in areas with chloroquine-susceptible infections. Administer artemisinin-based combination therapy in adult patients in areas with chloroquine-resistant infections. A Assess the G6PD status to guide administration of primaquine for preventing relapse. A Administer a 14-day course of primaquine for the treatment of P. vivax or P. ovale malaria in adult patients (except pregnant patients, patients breastfeeding infants aged < 6 months, patients breastfeeding older infants unless they are known not to be G6PD deficient, and patients with G6PD deficiency) to prevent relapse in all transmission settings. A Administer primaquine 0.5 mg/kg/day for 7 days as an additional treatment option for P. vivax or P. ovale malaria in adult patients (except pregnant patients, patients breastfeeding infants aged < 6 months, patients breastfeeding older infants unless they are known not to be G6PD deficient, and patients with G6PD deficiency) to prevent relapse. B Do not administer primaquine 1.0 mg/kg/ day for 7 days as an additional treatment option for P. vivax or P. ovale malaria to prevent relapse. D Consider administering primaquine base at 0.75 mg/kg body weight once weekly for 8 weeks, with close medical supervision for potential primaquine-induced hemolysis, to prevent relapse in patients with G6PD deficiency. C Decide on prescribing primaquine based on an assessment of the risks and benefits of adding primaquine when G6PD status is unknown and G6PD testing is not available. A Severity grading Q Does the patient have prostration/impaired consciousness? Q Does the patient have multiple convulsions? Q Does the patient have respiratory distress? Q Does the patient have pulmonary edema? Q Does the patient have circulatory collapse? Q Does the patient have abnormal bleeding? Q Does the patient have jaundice? Q Does the patient have Hgburia? Yes to any Classify patients as having severe malaria in the presence of 1 of the following criteria: prostration/impaired consciousness multiple convulsions respiratory distress pulmonary edema circulatory collapse abnormal bleeding jaundice hgburia. Management of severe malaria Antimalarial treatment Q Is severe malaria suspected on the basis of clinical manifestations or laboratory abnormalities? Yes Administer IV or intramuscularly artesunate for at least 24 hours for the treatment of adult patients with severe malaria (including infants, pregnant patients in all trimesters, and lactating patients) until they can tolerate oral medication. Complete treatment with 3 days of artemisinin-based combination therapy once the patient has received at least 24 hours of parenteral therapy and can tolerate oral therapy. A Administer artemether in preference to quinine for the treatment of adult patients with severe malaria if artesunate is not available. B Administer a single intramuscularly dose of artesunate in adult patients if complete treatment of severe malaria is not possible but injections are available, and refer them to an appropriate facility for further care. Administer intramuscularly artemether if intramuscularly artesunate is not available. Administer intramuscularly quinine if intramuscularly artemether is not available. B Do not use rectal artesunate in adult patients with severe malaria. D No Management of uncomplicated P. falciparum malaria Q Does the patient have P. falciparum malaria? Yes Administer any of the following artemisinin-based combination therapies for 3 days for the treatment of adult patients with uncomplicated P. falciparum malaria: artemether-lumefantrine artesunate-amodiaquine artesunate-mefloquine dihydroartemisinin-piperaquine artesunate plus sulfadoxine-pyrimethamine artesunate-pyronaridine. A Administer a single dose of 0.25 mg/kg body weight primaquine with artemisinin-based combination therapy in patients with P. falciparum malaria (except pregnant patients and patients breastfeeding infants aged < 6 months) to reduce transmission in low- transmission areas. Do not obtain G6PD testing. B Obtain close monitoring in patients with P. falciparum hyperparasitemia, in addition to artemisinin-based combination therapy, as they are at increased risk for treatment failure, severe malaria, and death. A No Management of uncomplicated P. vivax, P. ovale, P. malariae, or P. knowlesi malaria Q Is the patient a pregnant woman or a child < 6 months of age? Q Is the patient breastfeeding an infant < 6 months of age, or an older infant in whom glucose-6 phosphate dehydrogenase status is unknown? Q Does the patient have G6PD deficiency? Yes to any Treat patients with malaria as uncomplicated if the malaria species is not known with certainty. A Administer either artemisinin-based combination therapy or chloroquine in adult patients with uncomplicated P. vivax, P. ovale, P. malariae, or P. knowlesi malaria in areas with chloroquine-susceptible infections. Administer artemisinin-based combination therapy in adult patients in areas with chloroquine-resistant infections. A Assess the G6PD status to guide administration of primaquine for preventing relapse. A Administer a 14-day course of primaquine for the treatment of P. vivax or P. ovale malaria in adult patients (except pregnant patients, patients breastfeeding infants aged < 6 months, patients breastfeeding older infants unless they are known not to be G6PD deficient, and patients with G6PD deficiency) to prevent relapse in all transmission settings. A Administer primaquine 0.5 mg/kg/day for 7 days as an additional treatment option for P. vivax or P. ovale malaria in adult patients (except pregnant patients, patients breastfeeding infants aged < 6 months, patients breastfeeding older infants unless they are known not to be G6PD deficient, and patients with G6PD deficiency) to prevent relapse. B Do not administer primaquine 1.0 mg/kg/ day for 7 days as an additional treatment option for P. vivax or P. ovale malaria to prevent relapse. D Consider administering primaquine base at 0.75 mg/kg body weight once weekly for 8 weeks, with close medical supervision for potential primaquine-induced hemolysis, to prevent relapse in patients with G6PD deficiency. C Decide on prescribing primaquine based on an assessment of the risks and benefits of adding primaquine when G6PD status is unknown and G6PD testing is not available. A No to all Continue management and follow-up as clinically appropriate.