Malaria

Malaria, uncomplicated

Malaria, severe

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See: Primary Health Care STGs and EML - Malaria.

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MALARIA, UNCOMPLICATED

ICD-10 code: B50.0/B50.8-9/B51.0/B51.8-9/B52.9/B53.0/B53.8/B54

*Notifiable medical condition.

See: Primary Health Care STGs and EML: Malaria, Non-severe/uncomplicated.

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MALARIA, SEVERE

ICD-10 code: B50.0/B50.8

*Notifiable medical condition.

See: Primary Health Care STGs and EML: Malaria, severe/complicated.

DESCRIPTION 

P. falciparum malaria with one or more of the following features:

• severe general body weakness (prostration)
• abnormal bleeding (e.g. epistaxis)
• impaired consciousness
• convulsions
• renal dysfunction
• heavy parasitaemia (≥5%)
• repeated vomiting
• ARDS
• severe diarrhoea
• shock
• severe anaemia (Hb <6 g/dL)
• hypoglycaemia
• haemoglobinuria
• clinical jaundice
• acidosis (plasma bicarb <15 mmol/L)

GENERAL MEASURES

• Maintain hydration but avoid excessive fluid administration as this could contribute to the development of ARDS (especially in pregnancy).
• Transfuse if haemoglobin <6 g/dL.
• There is no convincing evidence of benefit for the use of exchange transfusion.

MEDICINE TREATMENT 

Intravenous therapy:

• Artesunate, IV, 2.4 mg/kg at 0, 12 and 24 hours; then daily until patient is able to tolerate oral therapy.
  • Administer at least 3 IV doses before switching to oral artemether/lumefantrine.

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Follow intravenous therapy with oral therapy:

• Artemether/lumefantrine 20/120 mg, oral, 4 tablets per dose, taken with fat-containing food or full cream milk to ensure adequate absorption.
  • Give the first dose immediately.
  • Give the second dose 8 hours later.
  • Then 12 hourly for another 2 days. (6 doses given over 3 days, i.e. 24 tablets in total).
• Monitor treatment response with regular blood smears.
• An increase in parasitaemia may occur within 24 hours due to release of sequestrated parasites, but a reduction should be seen after 48 hours.
• Gametocytes may appear after this stage – this does NOT mean failure of therapy as gametocytes may persist for up to 2 weeks after successful therapy. Only the reappearance of trophozoites or failure to clear them means failure.

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Consider concomitant bacteraemia in patients with severe malaria, especially if they have neutrophilia.

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REFERRAL

• Patient in need of ventilation or dialysis if these are unavailable on site.

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.2_20 January 2025

Chapter 9 Systemic and Healthcare-Associated Infections_9.7 Malaria