Malaria — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Severe?
   Confirmed malaria — does it meet WHO severe criteria? (Fever + blood film (thick/thin, for species and parasite density) and/or RDT; do not treat empirically if both negative (repeat if suspected). Severe falciparum = P. falciparum parasitemia + one of (without another cause): impaired consciousness/coma (GCS <11), prostration, repeated seizures, acidosis, hypoglycemia <2.2 mmol/L, severe anemia (Hb <7), renal impairment (Cr >265 µmol/L), jaundice, pulmonary edema/ARDS, bleeding/DIC, shock, high parasitemia >10%. Stay alert for imported cases.)
   • Severe falciparum malaria → Severe → IV artesunate
   • Uncomplicated malaria → Uncomplicated
2. [End] Uncomplicated
   A full course of oral artemisinin-based combination therapy (ACT); manage by species (P. vivax/ovale add primaquine to clear hypnozoites — check G6PD first); monitor, hydrate, treat fever; observe closely for signs of progression to severe disease.
3. [End] Severe → IV artesunate
   IV/IM artesunate (first-line, including in pregnancy) — 2.4 mg/kg (≥20 kg) or 3.0 mg/kg (<20 kg) at 0, 12, 24 h then daily, by slow IV push; after ≥24 h and able to take orally, switch to a full ACT course. ICU monitoring; IM artemether is second choice; quinine is no longer preferred. Supportive: correct hypoglycemia, cautious fluids (prevent pulmonary edema), control seizures, AKI (dialysis), transfuse for severe anemia, monitor parasite density/glucose; watch for delayed hemolysis.

Source guidelines & references

• WHO Guidelines for malaria treatment; management of severe malaria (ISCCM)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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