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7. Treatment of uncomplicated P. falciparum malaria

box 6.1
Summary of recommendations on parasitoloGical diaGnosis

 prompt parasitological confirmation by microscopy, or rdts, is recommended in all patients suspected
of malaria before treatment is started.
 treatment solely on the basis of clinical suspicion should only be considered when a parasitological
diagnosis is not accessible.

7. treatment of uncomplicated P. falciParum malaria

To counter the threat of resistance of P. falciparum to monotherapies, and to improve
treatment outcome, WHO recommends that artemisinin-based combination therapies
be used for the treatment of uncomplicated P. falciparum malaria (see also Annex 7).
Although the evidence base confirming the benefits of artemisinin-based combinations
has grown substantially in recent years, there is still substantial geographic variability in
the efficacy of available ACT options, underlining the importance of countries regularly
monitoring the efficacy of the ACTs in use to ensure that the appropriate ACT option(s)
is being deployed.

7.1 definition of uncomplicated malaria

Uncomplicated malaria is defined as symptomatic malaria without signs of severity or
evidence (clinical or laboratory) of vital organ dysfunction. The signs and symptoms of
uncomplicated malaria are nonspecific. Malaria is, therefore, suspected clinically mostly
on the basis of fever or a history of fever.

7.2 rationale for antimalarial combination therapy

Antimalarial combination therapy is the simultaneous use of two or more blood
schizontocidal medicines with independent modes of action and, thus, different
biochemical targets in the parasite. The rationale is twofold: i) the combination is often
more effective; and ii) in the very rare event that a mutant parasite resistant to one of the
medicines arises de novo during the course of the infection, this resistant parasite will be
killed by the other antimalarial medicine. This mutual protection is thought to prevent or
to delay the emergence of resistance. To realize the two advantages, the partner medicines
in a combination must independently be sufficiently efficacious in treating malaria.
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