Malaria, Severe/Complicated

Description

Medicine Treatment

Referral

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ICD-10 codes: B50.0/B50.8

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Note: notifiable medical condition.

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DESCRIPTION

Any one of the following is a sign of severe (complicated) malaria, is associated with a higher mortality, and requires urgent referral (after initial artesunate dose as below):

• prostration (severe general body weakness)
• sleepiness, confusion, unconsciousness or coma, convulsions
• respiratory distress and/or cyanosis
• jaundice
• renal failure
• shock
• repeated vomiting
• hypoglycaemia
• severe anaemia (Hb <7g/dL)
• haemoglobinuria/ black urine
• abnormal bleeding

MEDICINE TREATMENT

Treatment may be commenced before referral in clinics designated by the regional malaria control programme provided they have facilities to diagnose malaria (either microscopy or rapid antigen point of care tests) and healthcare workers trained in the management of severe malaria.
Correct hypoglycaemia immediately, if present.

Adults and children ≥ 20kg:

• Artesunate IM, 2.4mg/kg IM immediately as a single dose and refer urgently.
  • If transferral to referral hospital is delayed, administer second dose at 12 hours and third dose at 24 hours.

LoE:Ia²

Children < 20kg:                

• Artesunate IM, 3mg/kg immediately as a single dose and refer urgently.
  • If transfer to referral hospital is delayed, administer second dose at 12 hours and third dose at 24 hours.

LoE:IIIb³

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Note:
For all patients requiring referral, the patient must be transferred to reach the referral hospital within 6 hours of being seen at the PHC facility. 
Advise referral hospital that a loading dose has been administered.

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REFERRAL

Urgent

• All patients.

For dosing of artesunate, Click here. 

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.1_20 January 2025

Chapter 10: Infections and Related Conditions_10.7 Malaria_10.7.2 Malaria, severe/complicated