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.