Cyclic fever, travel to endemic area
ABCDE
A-B-C; IV artesunate for severe; treat hypoglycaemia/seizures; ICU for organ failure.
Confirm: Thick & thin smears (species + parasitemia)
Uncomplicated, sensitive → Chloroquine; add Primaquine for vivax/ovale (check G6PD first)
Falciparum / severe → IV artesunate
Prophylaxis: atovaquone-proguanil / mefloquine / doxycycline by region
Order set
- Thick + thin films (×3) / RDT
- FBC, U&E, LFTs, glucose
- Parasite count/species
Criteria
AdmitFalciparum or any severity features
ICUSevere: cerebral, ARDS, AKI, shock, high parasitaemia
IntubateCerebral malaria with ↓GCS
DialysisAKI with AEIOU
DischargeParasitaemia falling, oral tolerated, no severity features
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Severe: cerebral, AKI, ARDS, hypoglycaemia, parasitaemia >2%
Differentials
- Other travel fevers (typhoid, dengue)
- Sepsis
- Viral hepatitis
Common mistakes
- Single negative film excluding malaria
- Missing falciparum severity
- Under-dosing children <20 kg — artesunate 3 mg/kg/dose (WHO)
- Rectal artesunate 10 mg/kg pre-referral for children <6 y when IV impossible (WHO)
Disposition & follow-up
Uncomplicated → oral ACT; severe → IV artesunate + ICU; single-dose primaquine 0.25 mg/kg with ACT for P. falciparum in low-transmission settings (WHO, optional).
Discharge package
MedicationsComplete antimalarial course
Follow-upRepeat films if relapse; travel advice
LifestyleFuture prophylaxis + bite avoidance
Warning symptomsFever recurrence, drowsiness, dark urine
💊 Treatment detail — doses & preparation
Artesunate IVantimalarial (severe)
Dose2.4 mg/kg IV at 0, 12, 24 h then OD until oral tolerated (children <20 kg: 3 mg/kg/dose — WHO); then complete with a full 3-day ACT once oral tolerated
Preparation60 mg vial: reconstitute with bicarbonate then NS, slow push 3–5 min
MonitorParasite count 12-hourly; post-artesunate delayed haemolysis (Hb at 1–2 wk)
Artemether-lumefantrineACT (uncomplicated malaria)
Dose4 tablets at 0, 8 h then BD ×2 more days (6 doses) with fatty food
Preparation20/120 mg tablets — take with milk/fat for absorption
MonitorVomiting within 1 h → redose; QT; confirm species
Primaquine8-aminoquinoline
Dose0.25–0.5 mg/kg OD ×14 d (P. vivax/ovale hypnozoites) — AFTER G6PD test
Preparation7.5/15 mg tablets with food
MonitorG6PD deficiency = haemolysis — test first; avoid in pregnancy
📖 WHO / CDC MalariaReviewed July 2026