History of travel to malaria-endemic area or clinical suspicion of malaria
Perform thick and thin blood films and read within a few hours
No
Blood film positive?
Yes
Repeat blood films every 12 to 24 h for a total of 3 sets No Blood film positive? Yes
Calculate parasitemia Evaluate clinical status and disease severity
Consider alternate diagnoses
Uncomplicated malaria Determine species
Severe malaria and/or Patient unable to take oral medication
Non-falciparum species
Plasmodium falciparum or
species not yet identified
P. malariae
acquired outside Papua New Guinea or Indonesia
P. ovale or P. vivax
P. vivax acquired in
Papua New Guinea or Indonesia
P. knowlesi
Acquired in chloroquine- Acquired in chloroquine- Acquired in mefloquinesensitive area resistant area resistant area
Chloroquine or Hydroxychloroquine Atovaquone-proguanil or Artemether-lumefantrine or Quinine plus tetracycline or doxycycline or clindamycin or Mefloquine
Chloroquine or Hydroxychloroquine Chloroquine or Hydroxychloroquine
Atovaquone-proguanil or Quinine plus tetracycline or doxycycline or Mefloquine
Atovaquone-proguanil or Artemether-lumefantrine or Quinine plus tetracycline or doxycycline or clindamycin Intravenous quinidine plus tetracycline, or doxycycline, or clindamycin If quinidine is unavailable contact CDC malaria hotline for artesunate Admit to intensive care unit for continuous cardiac monitoring. Prevent and treat complications. Consider exchange transfusion if parasitemia is >10% or if patient has an altered mental status, ARDS, or renal failure Switch to oral medicines to complete the treatment regimen after appropriate clinical response
Plus
Primaquine if not G6PD deficient
Admit to hospital to monitor for progression of disease severity
Repeat blood films if symptoms recur