Algorithm for Diagnosis and Treatment of Malaria*

CDC Malaria Hotline: (770) 488-7788 or (855) 856-4713 (toll free), Monday–Friday, 9 am–5 pm EST; (770) 488-7100 after hours, weekends, and holidays

Fever and history of travel to malaria-endemic area, or clinical suspicion of malaria Evaluation

Disposition Perform thick and thin blood smears and read within few hours** Medication

No Blood film Yes positive?

Repeat blood films every 12–24 hours From smear: calculate parasitemia and (total of 3 times) determine species

No Blood film Yes positive? Evaluate clinical status and disease severity

Consider alternate diagnosis Uncomplicated Severe malaria and/or patient malaria unable to tolerate oral medication, regardless of species†

P. falciparum, P. knowlesi, P. ovale or P. vivax acquired in P. vivax P. malariae or species not yet area without chloroquine acquired in area Admit to intensive care unit. identified† resistance with Call CDC chloroquine Admit to hospital and monitor resistance for disease progression Chloroquine or Chloroquine or ‡ Intravenous artesunate (Call CDC) Hydroxychloroquine Hydroxychloroquine‡ Interim treatment: P. falciparum or species Artemether-lumefantrine not yet identified† or Artemether-lumefantrine Atovaquone-proguanil P. knowlesi or or Atovaquone-proguanil Quinine or or if no other options Chloroquine or Quinine plus tetracycline Mefloquine Hydroxychloroquine‡ or doxycycline or clindamycin or P. falciparum Mefloquine P. falciparum acquired P. falciparum acquired in area with in area with acquired in area with Monitor parasitemia no chloroquine chloroquine resistance mefloquine resistance every 12–24 hours resistance PLUS

Artemether-lumefantrine Artemether-lumefantrine If not G6PD deficient by (preferred) (preferred) quantitative testing: Administer follow on treatment or † or primaquine or after artesunate complete: Chloroquine or Atovaquone-proguanil Artemether-lumefantrine Hydroxychloroquine‡ Atovaquone-proguanil tafenoquine (not for children or or <16 years old) or Quinine plus tetracycline Quinine plus tetracycline Atovaquone-proguanil or doxycycline or or doxycycline or or clindamycin clindamycin Quinine and doxycycline (or or clindamycin) Mefloquine or if no other options Mefloquine

Footnotes * Treatment for special populations (children and pregnant women) can be found in the CDC Treatment Guidelines and Treatment Table. **If rapid diagnostic test performed, smear should also be performed with results available as soon as possible † If species later identified as P. vivax or P. ovale, add primaquine or tafenoquine if not G6PD deficient by quantitative testing ‡Drug options for chloroquine-resistant P. falciparum may be used