Algorithm for Management of Malaria

CDC Malaria Hotline: (770) 488-7788 or (855) 856-4713 (toll-free) Monday–Friday 9am–5pm EST
(770) 488-7100 after hours, weekends, and holidays

Fever and history of travel to malaria-

endemic area or clinical suspicion of malaria
Evaluation

Disposition
Perform thick and thin blood smears
and read within few hours* Medication

No Blood film Yes

positive?

Repeat blood films every

12-24 hours From smear: calculate parasitemia and
(total of 3 times) determine species

No Blood film
Yes
positive? Evaluate clinical status and
disease severity

Consider alternate
diagnosis
Uncomplicated Severe malaria and/or patient
malaria unable to tolerate oral
medication, regardless of species†

P. falciparum, P. knowlesi, P. ovale or P. vivax acquired in P. vivax

P. malariae area without chloroquine acquired in area Admit to intensive care unit.
or species not yet
identified† resistance with Call CDC
chloroquine
Admit to hospital and monitor resistance
for disease progression Chloroquine or Chloroquine or Intravenous artesunate (Call CDC)
Hydroxychloroquine‡ Hydroxychloroquine‡ Interim treatment:
P. falciparum or species Artemether-lumefantrine
not yet identified§ or
Atovaquone-proguanil Atovaquone-proguanil
or or
P. knowlesi
Artemether-lumefantrine Quinine
or or if no other options
Chloroquine or Quinine plus tetracycline Mefloquine
Hydroxychloroquine‡ or doxycycline or
clindamycin
or
P. falciparum Mefloquine
P. falciparum acquired P. falciparum
acquired in area with Monitor parasitemia
in area with acquired in area with
no chloroquine every 12–24 hours
chloroquine resistance mefloquine resistance
resistance PLUS

Atovaquone-proguanil If not G6PD deficient by

Atovaquone-proguanil quantitative testing: Administer follow on treatment
or
or Primaquine or after artesunate complete:†
Chloroquine or Artemether-lumefantrine
Artemether-lumefantrine tafenoquine (not for Artemether-lumefantrine
Hydroxychloroquine‡ or
or children <16 years old) or
Quinine plus tetracycline
Quinine plus tetracycline Atovaquone-proguanil
or doxycycline or
or doxycycline or or
clindamycin
clindamycin Doxycycline (or clindamycin)
or
or if no other options
Mefloquine
Mefloquine

Footnotes
*If rapid diagnostic test performed, smear should also be performed with results available as soon as possible
† If species later identified as P. vivax or P. ovale, add primaquine or tafenoquine if not G6PD deficient by quantitative testing
‡Drug options for chloroquine-resistant P. falciparum may be used