Uncomplicated Malaria- Management

A malaria case is defined as a person with malaria infection confirmed by microscopy or a malaria rapid diagnostic test (mRDT), regardless of whether fever or other clinical symptoms are present.

1. Asymptomatic Malaria Case

An asymptomatic malaria case may be identified through active case detection (ACD) by health workers in the community or households. All individuals with parasitemia are considered malaria cases, even in the absence of clinical symptoms.

2. Symptomatic Malaria Case

Uncomplicated Malaria

Uncomplicated malaria is symptomatic malaria without signs of severity or evidence (clinical or laboratory) of vital organ dysfunction.

Clinical presentation

• Fever

• Headache

• Joint pains

• Malaise

• Vomiting

• Diarrhoea

• Body aches and body weakness

• Poor appetite

• Pallor

• Enlarged spleen

Investigations

• Quality malaria microscopy OR quality malaria rapid diagnostic tests (mRDTs)

Note

• It is compulsory to test and confirm all suspected malaria patients. Antimalarial treatment should only be given to those who test positive.

• In cases of suspected treatment failure, microscopy is preferred because mRDTs may remain positive for up to 4 weeks after parasitemia has cleared due to persistent antigens.

1. Non-pharmacological management

• Continue feeding and fluid intake

• Follow up immediately if the condition worsens or on the fourth day if symptoms persist

2. Pharmacological treatment

First-line treatment (Uncomplicated malaria)

Artemether + Lumefantrine (ALu) (FDC) PO 20 mg + 120 mg

Common formulations

• Fixed combination: Artemether 20 mg + Lumefantrine 120 mg (6, 12, 18, 24 tablets blister packs)

• Fixed combination: Artemether 80 mg + Lumefantrine 480 mg (6 tablets blister pack)

• Dispersible pediatric tablets: Artemether 20 mg + Lumefantrine 120 mg

Pediatric dosing (5–14 kg)

• 1 tablet per dose

Pediatric dosing (15–24 kg)

• 2 tablets per dose

Table 1. Dosage regimen for ALu (artemether 20mg/lumefantrine 120mg)

Table 2: The recommended dosing schedule for ALu strength 80/480 mg

For practical purposes, a simpler dosage regimen is recommended in order to improve compliance: the first dose should be given as DOT; the second dose should strictly be given after 8 hours; subsequent doses could be given 12hourly in the second and third day of treatment until completion of 6 doses

The alternative medicines for the treatment of uncomplicated malaria, where there is no response to Artemether-Lumefantrine or it is contraindicated, is Dihydroartemisinin-Piperaquine.

dihydroartemisinin+piperaquine (FDC) (PO).

Adult formulation containing 40 mg Dihydroartemisinin + 320 mg Piperaquine. Paediatrics formulation contains a fixed combination of 20 mg of Dihydroartemisinin +160 mg Piperaquine.

Table 3: Dose Schedule for Dihydroartemisinin + Piperaquine

Management of fever

Patients with high fever (38.5⁰C and above) should be given an anti-pyretic medicine like paracetamol or acetylsalicylic acid every 4 to 6 hours (maximum 4 doses in 24 hours) until symptoms resolve, usually after two days.

Note

Children below 12 years should not be given acetylsalicylic acid because of the risk of developing Reye's syndrome.

Table 4: Treatment schedule for Paracetamol (500mg) Tablets Children 10mg/kg body weight