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Guidelines for the treatment of malaria – 2 edition

Recommendations were formulated based on the GRADE profiles with the strength of
recommendations rated as:
■ weak: the panel considers that the benefits of the intervention probably outweigh the
risks; or
■ strong: the panel is confident that the benefits of the intervention outweigh the risks.
The recommendations were modified where necessary with further consideration of
important factors beyond the scope of evidence so that strong recommendations may be
made on the basis of low quality evidence, and vice versa. These additional values and
preferences considered as important to the panel are described alongside presentation
of the tables.

1.3.2 Presentation of evidence (recommendations)

For clarity, these guidelines are presented in a simple descriptive form with a central main
document containing the recommendations. Summaries of the recommendations are given
in boxes together with the summary of the GRADE profiles, where available. In situations
where a GRADE table has not been constructed, it is so indicated in the recommendation
box. Full reviews of the evidence, the complete GRADE tables and additional references
are provided in annexes appropriately referenced in the main document.

2. clinical disease and epidemioloGy

Malaria is caused by infection of red blood cells with protozoan parasites of the genus
Plasmodium. The parasites are inoculated into the human host by a feeding female anopheline
mosquito. The four Plasmodium species that infect humans are P. falciparum, P. vivax,
P. ovale and P. malariae. Increasingly, human infections with the monkey malaria parasite,
P. knowlesi, have also been reported from the forested regions of South-East Asia.
The first symptoms of malaria are nonspecific and similar to the symptoms of a minor
systemic viral illness. They comprise: headache, lassitude, fatigue, abdominal discomfort,
and muscle and joint aches, usually followed by fever, chills, perspiration, anorexia,
vomiting and worsening malaise. Malaria is, therefore, frequently over-diagnosed on
the basis of symptoms alone, especially in endemic areas, because of this non-specificity
of symptomatology. At this early stage, with no evidence of vital organ dysfunction, the
patients can readily be treated with full rapid recovery provided prompt and effective
treatment is given. If, however, ineffective medicines are given or if treatment is delayed,
particularly in P. falciparum malaria, the parasite burden continues to increase and severe
malaria may ensue. It is a progression that may occur within a few hours. Severe malaria

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