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Guidelines for the treatment of malaria – 2 edition

in fixed-dose combinations, and otherwise used in combination with another effective
antimalarial concurrently or sequentially. As certain patient groups, such as pregnant
women and hyperparasitaemic patients, may need specifically tailored combination
regimens, artemisinin derivatives as single agents will still be needed in selected facilities
in the public sector, but they should be withdrawn from the private and informal sector.

In endemic regions, some semi-immune malaria patients could be cured using an
incomplete dose or treatment regimens that would be unsatisfactory in patients with no
immunity. In the past, this had led to different recommendations for patients considered
as semi-immune and those considered as non-immune. This practice is no longer
recommended. A full treatment course with a highly effective ACT is required whether
or not the patient is considered to be semi-immune.

Another potentially dangerous practice is to give only the first dose of the treatment
course for patients with suspected but unconfirmed malaria, with the intention of giving
full treatment if the diagnosis is eventually confirmed. This practice is also unsafe and
not recommended. If malaria is suspected and the decision to treat is made, then a full
effective treatment is required whether or not the diagnosis is confirmed by a test.

With the exception of lumefantrine, the partner medicines of all other ACTs have been
used previously as monotherapies, and amodiaquine, mefloquine and SP continue to be
available as monotherapy in many countries. Despite recommendations and warnings,
artemisinin derivatives are available as monotherapy in the market place in many
countries, and they are being used as such for the treatment of uncomplicated malaria.
The continued use of artemisinins or any of the partner medicines, such as monotherapies,
can compromise the value of ACTs by selecting for drug resistance.

7.7 additional considerations for clinical management

7.7.1 Can the patient take oral medication?
Some patients cannot tolerate oral treatment, and they will require parenteral or rectal
administration for 1–2 days until they can swallow and retain oral medication reliably.
Although such patients may never show other signs of severity, they should receive the
same initial antimalarial dose regimens as for severe malaria. Initial parenteral treatment
must always be followed by a full 3-day course of ACT (see Sections 8.4–8.7).

7.7.2 Use of antipyretics
Fever is a cardinal feature of malaria, and is associated with constitutional symptoms
of lassitude, weakness, headache, anorexia and often nausea. In young children, high
fevers are associated with vomiting, often regurgitating their medication, and seizures.
Treatment is with antipyretics and, if necessary, fanning and tepid sponging. Antipyretics

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