Severe Malaria Management

Diagnosis and Treatment

The World Health Organization recommends confirming severe malaria if any of the following criteria are present: impaired consciousness or coma, multiple convulsions, prostration, acute respiratory distress or pulmonary edema, circulatory shock, acute kidney injury or renal failure, acidosis, hyperlactatemia, severe anemia, hypoglycemia, high parasitemia, jaundice with organ dysfunction, or significant bleeding 1, 2
The Centers for Disease Control and Prevention recommends administering intravenous artesunate 2.4 mg/kg body weight at 0, 12, and 24 hours, then daily until the patient can tolerate oral medication 1, 2
The World Health Organization recommends not delaying treatment while awaiting transfer or confirmatory testing 2

The Centers for Disease Control and Prevention recommends monitoring continuously in the ICU: cardiac function and blood pressure, respiratory rate and oxygen saturation, urine output and renal function, blood glucose every 4 hours, plasma lactate and bicarbonate levels, and neurological status (Glasgow Coma Scale) 1, 2, 3
The World Health Organization recommends using restrictive fluid strategy to avoid pulmonary or cerebral edema 1, 2

The Centers for Disease Control and Prevention recommends treating hypoglycemia presumptively if clinical deterioration occurs, with 50 mL of 50% IV dextrose if glucose <40 mg/dL or if new neurological findings develop 2
The World Health Organization recommends considering acetaminophen 1 gram every 6 hours for 72 hours for reno-protective effects in patients with acute kidney injury 1, 3

The Centers for Disease Control and Prevention recommends starting empiric antibiotics only if bacterial co-infection is suspected, and continuing only if blood cultures are positive 1, 2, 3
The World Health Organization recommends avoiding harmful interventions, such as corticosteroids and exchange blood transfusion 1, 2, 3

The Centers for Disease Control and Prevention recommends switching to oral artemisinin-based combination therapy (ACT) once the patient can tolerate oral medication and parasitemia has declined to <1% 1, 4
The World Health Organization recommends completing a full 3-day course of oral ACT after IV artesunate 1, 4