At a glance
- CDC provides malaria treatment tables that can guide treatment of malaria in the United States.
- Healthcare providers may call CDC's Malaria Clinical Consult Service hotline with diagnosis and treatment questions.
Clinical resources
CDC Malaria Clinical Consult Service
Call CDC's malaria hotline for questions about malaria diagnosis and treatment:
- Monday – Friday, 9 a.m. 5 p.m. EST: (770) 488-7788 or (855) 856-4713 (toll free)
- After hours, weekends, and federal holidays: (770) 488-7100
Reference Algorithm for Diagnosis and Management of Malaria for a summary of the recommended steps to evaluate, diagnose, and treat malaria patients.
Review clinical guidance of malaria diagnosis and treatment in the United States for more details on treatment of uncomplicated malaria and severe malaria.
Malaria treatment tables
Malaria treatment tables provide the drug or drug combination recommended for each specific situation, as well as the adult and pediatric doses. Note, where appropriate, that the antimalarial dose is expressed in base with the salt equivalency and its corresponding number of tablets needed in the United States noted in parentheses.A
Table 1. P. falciparum or species unknown: uncomplicated malaria
Download PDF version of treatment tables.
Treatment options for infections acquired in any malaria-endemic area (including chloroquine resistant areas)
Treatment options for infections acquired in any malaria-endemic area (including chloroquine resistant areas)
Listed in order of preference:
A. Artemether-lumefantrine (Coartem®)3,4 (1 tab: 20 mg artemether and 120 mg lumefantrine)
Adults: 4 tabs po per dose
Five-day course5:
Day1: Initial dose and second dose 8 h later
Days 2–5: BID
dosing
Listed in order of preference:
A. Artemether-lumefantrine (Coartem®)3,4 (1 tab: 20 mg artemether and 120 mg lumefantrine)
5–<15 kg: 1 tab po per dose
15–<25 kg: 2 tabs po per dose
25–<35 kg: 3 tabs po per
dose
≥35 kg: 4 tabs po per dose
Five-day course5:
Day 1: Initial dose and second
dose 8 h later
Days 2–5: BID
dosing
OR
B. Atovaquone-proguanil (Malarone™)3,6 (Adult tab: 250 mg atovaquone and 100 mg proguanil)
4 adult tabs po QD x 3 days
OR
B. Atovaquone-proguanil (Malarone™)3,6 (Adult tab: 250 mg atovaquone and 100 mg proguanil; Peds tab: 62.5 mg atovaquone and 25 mg proguanil)
5–<8 kg: 2 peds tabs po QD x 3 days
8–<10 kg: 3 peds tabs po QD x 3 days
10–<20 kg: 1 adult tab po QD x 3 days
20–<30 kg: 2 adult tabs po QD x 3 days
30–<40 kg: 3 adult tabs po QD x 3 days
≥40 kg: 4 adult tabs po QD x 3 days
OR
C. Quinine sulfate7 plus doxycycline8
Quinine sulfate: 542 mg base (650 mg salt) (= 2 tabs in US) po TID x 7 days;
Doxycycline: 100 mg po BID x 7 days
OR
C. Quinine sulfate7 plus doxycycline8 (or clindamycin)9
Quinine sulfate: 8.3 mg base/kg (10 mg salt/kg) po TID x 7 days;
Doxycycline: 2.2 mg/kg po BID x 7 days; or
Clindamycin: 20 mg/kg/day po divided TID x 7 days
OR
D. Mefloquine (only when other options cannot be used)10
Dose 1: 684 mg base (750 mg salt) po (= 3 tabs in US) Dose 2 at 6 to 12 h: 456 mg base (500 mg salt) po (= 2 tabs in US)
OR
D. Mefloquine (only when other options cannot be used)10
Dose 1: 13.7 mg base/kg (15 mg salt/kg) po
Dose 2 at 6 to 12 h: 9.1 mg base/kg (10 mg salt/kg) po
Abbreviations: QD=once a day, BID=twice a day, TID=three times a day, QID=four times a day, h=hour(s), po=by mouth, tab(s)=tablet(s).
If later diagnosed as P. vivax or P. ovale, see Table 2 for anti-relapse treatment. If pregnant woman, see Table 4.
1 If an antimalarial was taken for chemoprophylaxis, a different drug should be used for treatment.
2 Not to exceed adult dose.
3 To maximize absorption, artemether-lumefantrine and atovaquone-proguanil should be taken with a fatty food or a milky drink.
4 Artemether-lumefantrine can be used in pregnancy. Not for infants <5 kg or women breastfeeding infants <5 kg.
5 Artemether-lumefantrine should be extended to a 5-day course due to multiple factors including its safety profile, immune status, and body size of U.S. travelers, and increasing spread of artemisinin partial resistance and decreasing lumefantrine susceptibility.
6 Atovaquone-proguanil is not recommended during pregnancy, in infants <5 kg, or in women breastfeeding infants <5 kg. May be considered if other treatment options are not available or not tolerated, and benefits outweigh risks.
7 Quinine available in the US has 324 mg (salt) per capsule; therefore, 2 capsules are needed for adult dosing. Pediatric dosing may be available at a compounding pharmacy. If a preferred treatment regimen (artemether-lumefantrine or atovaquone-proguanil) becomes available, switch due to potential side effects of quinine and complete a full course.
8 Tetracycline (adult dose: 250 mg po QID x 7 days; pediatric dose: 25 mg/kg/day po divided QID x 7 days) can be used for individuals ≥8 years old.
9 Clindamycin with quinine is an alternative option for children <8 years old.
10 Mefloquine increases risk of post-malaria neurological syndrome and is contraindicated in patients with epilepsy or neuropsychiatric disorders. In addition, mefloquine is not recommended for infections acquired in Southeast Asia due to drug resistance.
Table 2. P. vivax or P. ovale: uncomplicated malaria
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Acute treatment options for infections acquired in chloroquine-sensitive areas (all malaria endemic areas except Papua New Guinea or Indonesia)
Note: Regimens used to treat chloroquine-resistant P. vivax infections may be used if chloroquine or hydroxychloroquine is not readily available.
Acute treatment options for infections acquired in chloroquine-sensitive areas (all malaria endemic areas except Papua New Guinea or Indonesia)
Note: Regimens used to treat chloroquine-resistant P. vivax infections may be used if chloroquine or hydroxychloroquine is not readily available.
Chloroquine phosphate (Aralen™ and generics)
Dose 1: 600 mg base (1,000 mg salt) po
Doses 2 to 4 (3 additional
doses) at 6, 24 and 48 h: 300 mg base (500 mg salt) po per dose
Chloroquine phosphate (Aralen™ and generics)
Dose 1: 10 mg base/kg (16.7 mg salt/kg) po
Doses 2 to 4 (3 additional doses)
at 6, 24 and 48 h: 5 mg base/kg (8.3 mg salt/kg)
po per dose
OR
Hydroxychloroquine (Plaquenil™ and generics)
Dose 1: 620 mg base (800 mg salt) po
Doses 2 to 4 (3 additional
doses) at 6, 24 and 48 h: 310 mg base (400 mg salt) po per dose
OR
Hydroxychloroquine (Plaquenil™ and generics)
Dose 1: 10 mg base/kg (12.9 mg salt/kg) po
Doses 2 to 4 (3 additional doses)
at 6, 24 and 48 h:
5 mg base/kg (6.5 mg salt/kg) po per dose
Acute treatment options for infections acquired in all malaria endemic areas (including chloroquine-resistant regions in Papua New Guinea and Indonesia)
Acute treatment options for infections acquired in all malaria endemic areas (including chloroquine-resistant regions in Papua New Guinea and Indonesia)
Listed in order of preference:
A.
Artemether-lumefantrine (Coartem®)3,4 (1 tab: 20 mg artemether and 120 mg lumefantrine)
Adults: 4 tabs po per dose
Three-day course:
Day 1: Initial dose and second dose 8 h later
Days 2 and 3: BID dosing
OR
Atovaquone-proguanil (MalaroneTM)4,5 (Adult tab: 250 mg atovaquone and 100 mg proguanil)
4 adult tabs po QD x 3 days
Listed in order of preference:
A. Artemether-lumefantrine (Coartem®)3,4 (1 tab: 20 mg artemether and 120 mg lumefantrine)
5–<15 kg: 1 tab po per dose
15–<25 kg: 2 tabs po per dose
25–<35 kg: 3 tabs po per dose
≥35 kg: 4 tabs po per dose
Three-day course:
Day 1: Initial dose and second dose 8 h later
Days 2 and 3: BID dosing
OR
Atovaquone-proguanil (MalaroneTM)4,5 (Adult tab: 250 mg atovaquone and 100 mg proguanil; Peds tab: 62.5 mg atovaquone and 25 mg proguanil)
5–<8 kg: 2 peds
tabs po QD x 3 days
8–<10 kg: 3 peds tabs po QD x 3 days
10–<20 kg: 1 adult tab po QD x 3 days
20–<30 kg: 2 adult tabs po QD x 3 days
30–<40 kg: 3 adult tabs po QD x 3 days
≥40 kg: 4
adult tabs po QD x 3 days
OR
B. Quinine sulfate6 plus doxycycline7
Quinine sulfate: 542 mg base (650 mg salt) po
TID x 7 days;
Doxycycline: 100 mg po BID x 7 days
OR
B. Quinine sulfate6 plus doxycycline7 (or clindamycin8)
Quinine sulfate: 8.3 mg base/kg (10 mg salt/kg) po TID x 7 days;
Doxycycline: 2.2 mg/kg po BID x 7 days; or
Clindamycin: 20 mg /kg/day po divided TID x 7 days
OR
C. Mefloquine (only when other options cannot be used)9
Dose 1: 684 mg base (750 mg salt) po
Dose 2 at 6 to 12 h: 456 mg base (500 mg salt) po
OR
C. Mefloquine (only when other options cannot be used)9
Dose 1: 13.7 mg base/kg (15 mg salt/kg) po
Dose 2 at 6 to 12 h: 9.1 mg base/kg (10 mg salt/kg) po
Anti-relapse treatment10: Prior to use, quantitative G6PD testing needed to confirm normal activity
Anti-relapse treatment10: Prior to use, quantitative G6PD testing needed to confirm normal activity
Primaquine phosphate11,12
30 mg base (52.6 mg salt) (= 2 tabs in US) po qd x 14 days
≥70kg dose should be adjusted to a total dose of 6 mg/kg, divided into doses of 30 mg per day
OR
Tafenoquine (KrintafelTM)12,13
300 mg po x 1 dose
Primaquine phosphate11,12
0.5 mg/kg base (0.8 mg/kg salt) po qd x 14 days
OR
Tafenoquine (KrintafelTM)12, 13
300 mg po x 1 dose, only for patients ≥16 years old
Abbreviations: QD=once a day, BID=twice a day, TID=three times a day, QID=four times a day, h=hour(s), po=by mouth, tab(s)=tablet(s).
1 If an antimalarial was taken for chemoprophylaxis, a different drug should be used for treatment.
2 Not to exceed adult dose.
3 To maximize absorption, artemether-lumefantrine and atovaquone-proguanil should be taken with a fatty food or a milky drink.
4 Artemether-lumefantrine can be used in pregnancy. Not for infants <5 kg or women breastfeeding infants <5 kg.
5 Atovaquone-proguanil not recommended during pregnancy, in infants <5 kg, or in women breastfeeding infants <5 kg. May be considered if other treatment options not available or not tolerated, and benefits outweigh risks.
6 Quinine available in the United States has 324 mg (salt) per capsule; therefore, 2 capsules are needed for adult dosing. Pediatric dosing may need compounding pharmacy. If a preferred treatment regimen (artemether-lumefantrine or atovaquone-proguanil) becomes available, switch due to potential side effects of quinine and complete a full course.
7 Tetracycline (adult dose: 250 mg po QID x 7 days; pediatric dose: 25 mg/kg/day po divided QID x 7 days) can be used for individuals ≥8 years old.
8 Clindamycin with quinine is an alternative option for children <8 years old.
9 Mefloquine increases risk of post-malaria neurological syndrome and is contraindicated in patients with epilepsy or neuropsychiatric disorders. In addition, mefloquine is not recommended for infections acquired in Southeast Asia due to drug resistance.
10 Either option for anti-relapse treatment is recommended if chloroquine or hydroxychloroquine was used for acute treatment. If regimens other than either chloroquine or hydroxychloroquine were used for acute treatment, primaquine is the only option for anti-relapse treatment. Primaquine and tafenoquine are associated with hemolytic anemia in those with glucose-6-phosphate dehydrogenase (G6PD) deficiency.
11 Primaquine available in the United States has 15 mg (base) per capsule; therefore, 2 capsules are needed for adult dosing. For those with intermediate G6PD deficiency, weekly primaquine may be used (45 mg per week) for 8 weeks with close monitoring for hemolysis. For those with G6PD deficiency, consultation with an expert in infectious disease or malaria is advised to discuss alternative regimens; however, they may be given chloroquine 300 mg base (500 mg salt) po weekly for 1 year from acute infection to prevent relapses.
12 Primaquine and tafenoquine must not be used during pregnancy; pregnant patients with P. vivax and P. ovale infections should receive chloroquine 300 mg base (500 mg salt) po weekly after acute treatment for the remainder of pregnancy. If the patient acquired P. vivax infection in an area with chloroquine-resistant P. vivax infections, consultation with an expert in infectious disease or malaria is advised to discuss alternative regimens. After delivery, patients with normal G6PD activity can be given primaquine or tafenoquine depending on breastfeeding status or continue with chloroquine prophylaxis for a total of 1 year from acute infection. Primaquine or tafenoquine can be used during breastfeeding if the infant has normal G6PD activity.
13 Tafenoquine should only be used if G6PD quantitative acidity is normal and chloroquine or hydroxychloroquine is administered concurrently for acute treatment due to limited data on efficacy when used in combination with other regimens.
Table 3. P. malariae or P. knowlesi: uncomplicated malaria
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Treatment options3 for infections acquired in all malaria-endemic areas (no widespread chloroquine resistance). Chloroquine and hydroxychloroquine should only be used if a mono-infection with P. malariae or knowlesi has been confirmed, ideally by PCR, as these species can be confused with P. falciparum on smear.
Treatment options3 for infections acquired in all malaria-endemic areas (no widespread chloroquine resistance). Chloroquine and hydroxychloroquine should only be used if a mono-infection with P. malariae or knowlesi has been confirmed, ideally by PCR, as these species can be confused with P. falciparum on smear.
A. Chloroquine phosphate (AralenTM and generics)
Dose 1: 600 mg base (1,000 mg salt) po
Doses 2 to 4 (3 additional doses) at 6, 24 and 48 h:
300 mg base (500 mg salt) po per dose
OR
Hydroxychloroquine (Plaquenil™ and generics)
Dose 1: 620 mg base (800 mg salt) po
Doses 2 to 4 (3 additional doses) at 6, 24 and 48 h: 310 mg base (400 mg salt) po per dose
A. Chloroquine phosphate (AralenTM and generics)
Dose 1: 10 mg base/kg (16.7 mg salt/kg) po
Doses 2 to 4 (3 additional doses) at 6, 24 and 48 h: 5 mg base/kg (8.3 mg salt/kg) po per dose
OR
Hydroxychloroquine (Plaquenil™ and generics)
Dose 1: 10 mg base/kg (12.9 mg salt/kg) po
Doses 2 to 4 (3 additional doses) at 6, 24 and 48 h:
5 mg base/kg (6.5 mg salt/kg) po per dose
OR
B. Artemether-lumefantrine (Coartem®)4,5
(1 tab: 20 mg artemether and 120 mg lumefantrine)
Adults: 4 tabs po per dose
Three-day course:
Day 1: Initial dose and second dose 8 h later
Days 2 and 3: BID dosing
OR
C. Atovaquone-proguanil (Malarone™)4,6 (Adult tab: 250 mg atovaquone and 100 mg proguanil)
4 adult tabs po QD x 3 days
OR
C. Atovaquone-proguanil (Malarone™)4,6 (Adult tab: 250 mg atovaquone and 100 mg proguanil; peds tab: 62.5 mg atovaquone and 25 mg proguanil)
5–<8 kg: 2 peds
tabs po QD x 3 days
8–<10 kg: 3 peds
tabs po QD x 3 days
10–<20 kg: 1 adult tab po QD x 3 days
20–<30 kg: 2 adult tabs po QD x 3 days
30–<40 kg: 3 adult tabs po QD x 3 days
≥40 kg: 4 adult tabs po QD x 3 days
Abbreviations: QD=once a day, BID=twice a day, TID=three times a day, QID=four times a day, h=hour(s), po=by mouth, tab(s)=tablet(s).
1 If an antimalarial was taken for chemoprophylaxis, a different drug should be used for treatment.
2 Additional options include quinine plus doxycycline/ tetracycline (or clindamycin) or, if no alternatives are available, mefloquine. See Table 1 for dosing.
3 Not to exceed adult dose.
4 To maximize absorption, artemether-lumefantrine and atovaquone-proguanil should be taken with fatty food or a milky drink.
5 Artemether-lumefantrine can be used in pregnancy. Not for infants <5 kg or women breastfeeding infants <5 kg.
6 Atovaquone-proguanil not recommended during pregnancy, in infants <5 kg, or in women breastfeeding infants <5 kg. May be considered if other treatment options are not available or not tolerated, and benefits outweigh risks.
Table 4. Pregnant women: uncomplicated malaria
Download PDF version of treatment tables.
Plasmodium falciparum or species unknown
Plasmodium vivax or Plasmodium ovale
Plasmodium malariae or Plasmodium knowlesi
All Trimesters (refer to Table 1 for dosing):
- Artemether-lumefantrine (Coartem®)3 (preferred); or
- Quinine sulfate
plus clindamycin; or
- Mefloquine (only if no other options available)
Additional
treatment options available only if infection acquired in chloroquine sensitive
areas (Central America west of Panama Canal, Haiti, and Dominican Republic)
- Chloroquine phosphate (Aralen™
and generics); or
- Hydroxychloroquine (Plaquenil™ and generics)
All Trimesters (refer to Table 2 for dosing)
Acute treatment for infections acquired in all malaria-endemic regions except Papua New Guinea or Indonesia:
- Chloroquine phosphate (Aralen™ and generics); or
- Hydroxychloroquine (Plaquenil™ and generics)
Acute treatment for infections acquired in Papua New Guinea or Indonesia (may be used if chloroquine and hydroxychloroquine not readily available for infections acquired in other areas):
- Artemether-lumefantrine (Coartem®)3 (preferred); or
- Quinine sulfate
plus clindamycin; or
- Mefloquine (only if no other options
available)
All Trimesters4 (refer to Table 3 for dosing)
- Chloroquine phosphate (Aralen™ and generics); or- Hydroxychloroquine (Plaquenil™ and generics);
or
- Artemether-lumefantrine (Coartem®)3
Anti-relapse (treatment with either primaquine or tafenoquine contraindicated during pregnancy)
- Chloroquine 300 mg base (500 mg salt) weekly until delivery, then consider anti-relapse treatment (refer to Table 2 for options and dosing)
Abbreviations: QD=once a day, BID=twice a day, TID=three times a day, QID=four times a day, h=hour(s), po=by mouth, tab(s)=tablet(s).
1 If an antimalarial was taken for chemoprophylaxis, a different drug should be used for treatment.
2 Atovaquone-proguanil is not listed due to insufficient data on its safety during pregnancy but may be considered if other treatment options are not available or not tolerated, and benefits outweigh potential risks.
3 Artemether-lumefantrine can be used in all trimesters in pregnancy per WHO evidence review and policy.
4 Additional options include quinine plus clindamycin or, if no alternatives are available, mefloquine. See Table 1 for dosing.
Table 5: Severe malaria
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Start IV artesunate promptly (recommended for all species and infections acquired in all areas):
Commercially available from major distributors.
1 dose=2.4 mg/kg IV2
Initial
course: 3 doses in total at 0, 12 and 24 hours
Continued QD
up to 6 additional days (for a total of 7 days of IV artesunate) until the
parasitemia is ≤1%, and the patient is able to tolerate oral medication.
If IV artesunate is not
readily available, give oral antimalarials while obtaining IV artesunate. When IV artesunate arrives, discontinue oral antimalarial and initiate IV treatment. Interim treatment options
(refer to Table 1 for dosing):
A. Artemether-lumefantrine (Coartem®)(preferred); or
B. Atovaquone-proguanil (Malarone™); or
C. Quinine sulfate; or
D. Mefloquine (only if no other options available)
If oral therapy is not tolerated, consider administration via nasogastric tube or after an antiemetic.
Reassess percentage
of parasitemia at least 4 hours after the third dose
of IV artesunate:
Parasitemia ≤1% and the patient is able to tolerate oral medications: Give a complete follow-on oral regimen regardless of the interim drug used or the previous doses administered. If parasitemia is <1% but oral therapy is not tolerated, can extend IV artesunate or administering oral follow-on therapy via nasogastric tube or after an antiemetic based on clinical status.
Options include3 (refer to Table 1 for dosing):
- Artemether-lumefantrine (Coartem®), or
- Atovaquone-proguanil (MalaroneTM)
Parasitemia >1%: Continue IV artesunate, same dose, QD up to 6 more days (for a total of 7 days of IV artesunate) until parasitemia is ≤1%. When the parasitemia is ≤1%, give complete follow-on oral regimen. (Refer to Table 1 for options and dosing).
If P. vivax or P. ovale infections, in addition to acute treatment listed here, anti-relapse treatment is needed. (Refer to Table 2 for dosing).
Abbreviations: QD=once a day, IV=intravenous
1 Laboratory-confirmed or suspected malaria cases with ≥1 clinical criteria for severe disease (impaired consciousness/ convulsions/ coma, severe anemia [hemoglobin <7mg/dl], acute kidney injury, pulmonary edema/ acute respiratory distress syndrome/ hypoxemia, circulatory collapse/ shock, spontaneous bleeding/ disseminated intravascular coagulation, acidosis, jaundice); and/ or parasite density ≥5%.
2 Current dosing in small children <20kg at 2.4mg/kg is based on an FDA analysis modeling pharmacokinetics in a population created from the CDC growth charts. Note WHO recommends 3mg/kg dosing for children <20kg based on modeling the relationship between body weight and age of African children presenting with severe malaria.
3 Additional options include quinine plus doxycycline/tetracycline (or clindamycin) or, if no alternatives are available, mefloquine. See Table 1 for dosing.
- Use of trade names is for identification only and does not imply endorsement by the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry, the Public Health Service, or the U.S. Department of Health and Human Services.