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Patient handout

Malaria (uncomplicated + severe)

PRODUCTION

1. Your condition

This handout is for malaria (uncomplicated + severe). Your care team identified this based on: fever in returned traveler from endemic region (idsa 2024).

Other reasons your team may use this plan: cyclical fever, chills, diaphoresis (idsa 2024); jaundice, anemia, splenomegaly with fever (idsa 2024); resident of malaria-endemic region with fever (idsa 2024).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

MedicationStarting doseHowWhenWhat it does
artesunate_iv2.4 mg/kg IV at 0, 12, 24 h then dailyIV0/12/24 h then daily until tolerating POSEAQUAMAT / AQUAMAT — superior to quinine (IDSA 2024)
artemether_lumefantrine4 tablets BID × 3 d (≥35 kg)POBID × 3 dMost widely used ACT (IDSA 2024)
quinine20 mg/kg IV load + 10 mg/kg q8hIVload + q8hBackup; cinchonism, hypoglycemia (IDSA 2024)
clindamycin20 mg/kg/d dividedIV/POTIDPregnancy 1st trimester regimen with quinine (IDSA 2024)

Plan: Severe malaria — IV artesunate then ACT (IDSA 2024)

3. When to call your provider

Contact your care team if any of the following happen:

  • Severity criteria → ED (IDSA 2024)
  • Pregnancy → admit (IDSA 2024)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

  • WHO severe malaria criteria — GCS <11, seizure, lactate >5, parasitemia >5%, hypoglycemia, Hb <7, AKI, jaundice, shock, DIC, pulm edema(life-threatening)
  • Coma / GCS <11 with falciparum (IDSA 2024)(life-threatening)
  • Malaria in pregnancy (IDSA 2024)
  • Hgb drop ≥10% with rising LDH 7–28 d after artesunate (IDSA 2024)
  • Treatment failure or recurrence (IDSA 2024)
  • Parasitemia ≥ 5% in non-immune patient OR ≥ 10% in semi-immune endemic patient — independent prognostic for severe malaria (WHO 2023; SEAQUAMAT)
  • Persistent parasitemia day 3 OR fever clearance > 72 h on artemisinin OR kelch13 mutation detected — emerging in East Africa (Uganda, Rwanda, Eritrea) + Greater Mekong (WHO 2023; Balikagala NEJM 2021; Conrad 2023)

5. Follow-up

ID clinic, chemoprophylaxis counselling, relapse counselling vivax/ovale (IDSA 2024)

6. Sources

Guideline: WHO 2023 Guidelines for the Treatment of Malaria; CDC Yellow Book 2024

  1. pubmed.ncbi.nlm.nih.gov/16125588
  2. pubmed.ncbi.nlm.nih.gov/21062666
  3. pubmed.ncbi.nlm.nih.gov/30650322