Treatment of Malaria in the United States

Uncomplicated malaria due to P. falciparum or unknown species acquired in all malarious regions (additional options for malaria acquired in chloroquine-sensitive regions listed below)—Oral drugs

Recommended drug

Artemether/lumefantrineArtemether/lumefantrine

or

Atovaquone/proguanilAtovaquone/proguanil

or

Quinine sulfate Quinine sulfateplus one of the following:

• DoxycyclineDoxycycline

• TetracyclineTetracycline

• ClindamycinClindamycin

Alternative (if other options cannot be used)

MefloquineMefloquine

Additional options for uncomplicated malaria due to P. falciparum or unidentified species acquired in chloroquine-sensitive areas (Central America west of Panama Canal, Haiti, Dominican Republic, most of the Middle East), and P. malariae and P. knowlesi in all regions. If the unidentified species could be P. vivax or P. ovale, terminal treatment with primaquine or tafenoquine is given to prevent relapse (see below)—Oral drugs , terminal treatment with primaquine or tafenoquine is given to prevent relapse (see below)—Oral drugs

Drugs ⁱ

ChloroquineChloroquine

or

HydroxychloroquineHydroxychloroquine

or

Artemether/lumefantrineArtemether/lumefantrine

Uncomplicated malaria due to P. vivax (outside of Papua New Guinea and Indonesia where chloroquine resistance is prevalent) or P. ovale in all regions—Oral drugs

Recommended drugsⁱ

ChloroquineChloroquineor

HydroxychloroquineHydroxychloroquine

plus

PrimaquinePrimaquine

or

Tafenoquine Tafenoquine

For patients ≥ 16 years, adult dose

Only recommended for use with chloroquineOnly recommended for use with chloroquine

Uncomplicated malaria due to P. vivax acquired in areas known to harbor chloroquine-resistant P. vivax ^m (Papua New Guinea, Indonesia)—Oral drugs

Recommended drugs

Artemether/lumefantrineArtemether/lumefantrine

or

Atovaquone/proguanilAtovaquone/proguanil

or

Quinine Quinineplus one of the following:

• DoxycyclineDoxycycline

• TetracyclineTetracycline

or

MefloquineMefloquine

plus, with any of the above regimens

PrimaquinePrimaquine

or

Tafenoquine Tafenoquine

For patients ≥ 16 years, adult dose

Only recommended for use with quinineOnly recommended for use with quinine

Severe malaria, all Plasmodium—Parenteral drugs

Recommended drugs

IV artesunate, commercially available, but if it cannot be obtained within 24 hours, contact the IV artesunate, commercially available, but if it cannot be obtained within 24 hours, contact theCDC Malaria Hotline

(If IV artesunate is not immediately available, start interim oral artemether/lumefantrine or other alternatives. When artesunate arrives, discontinue oral therapy.)(If IV artesunate is not immediately available, start interim oral artemether/lumefantrine or other alternatives. When artesunate arrives, discontinue oral therapy.)

Reassess parasite density 4 or more hours after third dose. When parasite density is < 1% and patient able to tolerate oral therapy, start oral treatment with one of the following:

Artemether/lumefantrine (preferred)Artemether/lumefantrine (preferred)

Atovaquone/proguanilAtovaquone/proguanil

Quinine plus doxycycline (age > 8 years and not pregnant)Quinine plus doxycycline (age > 8 years and not pregnant)

Quinine plus clindamycin (in children < 8 years and pregnant patients)Quinine plus clindamycin (in children < 8 years and pregnant patients)

plus, if P. vivax or P. ovale is likely or confirmed

PrimaquinePrimaquine

Tafenoquine Tafenoquine