Table 8 Recommendations

When should malaria be suspected?

In all ill patients with a travel history of visiting amalaria endemic area in the last year, especially inthe last 3 months.

Initial diagnosis

Microscopy of thick and thin Giemsa stained bloodfilms. Use of a rapid diagnostic test can be used ifmicroscopy is unavailable initially, but follow upby microscopy is essential.

Monitoring after diagnosis

Microscopy of thick and thin Giemsa stained bloodfilms. If this skill is not available the patient shouldbe transferred to a level where microscopy can be performed.

Treatment of uncomplicated malaria

See tables1 and2. Artemisinin combination therapy or atovaquone-proguanil are first linetreatment options for P.falciparum and can also be used for the other species. Chloroquine is the first line treatment for other malaria species.

Treatment of complicated malaria

Artesunate or quinine intravenously. If available,artesunate is preferable to quinine. These drugs must be available at the health care facility managing patients with malaria.

Treatment of non-falciparum malaria

Chloroquine is the drug of choice and ACT a pragmatic alternative. In case of chloroquine resistance an ACT is second line treatment.

Primaquine is given after testing for G6PD at adose of 30 mg per day for patients infected in Southeast Asia; otherwise 15 mg/day.

Managing uncomplicated malaria

Patients with P. falciparum malaria should preferably be managed as in-patients. Under certain circumstances out-patient management may be acceptable provided there are daily assessments and daily blood films for parasitaemia until clinical and parasitological cure.

Managing complicated malaria

Patients with complicated P. falciparum malaria (Table4) should be managed as inpatients in anIntensive Care Unit.

Patients receiving intravenous artesunate should be monitored twice weekly for 4 weeks following IVA for hemolysis and leucopenia.