At a glance
- Table 1. Uncomplicated malaria: Plasmodium falciparum or unknown species
- Table 2. Uncomplicated malaria: P. vivax or P. ovale
- Table 3. Uncomplicated malaria: P. malariae or P. knowlesi
- Table 4. Uncomplicated malaria: Pregnant women
- Table 5: Severe malaria
- CDC Malaria Hotline: (770) 488-7788 or (855) 856-4713 (toll free) Mon–Fri, 9 am–5 pm EST; (770) 488-7100 after hours, weekends, and holidays
Table 1. Uncomplicated malaria: Plasmodium falciparum or unknown species 1, 2, 3
(If later diagnosed as P. vivax or P. ovale, see Table 2 for antirelapse treatment)
Download PDF version of Treatment Tables.
Drug Susceptibility
(Based on where acquired)
Recommended Adult Regimens
Recommended Pediatric Regimens4
Chloroquine resistant or unknown resistance
(All malaria- endemic regions except those in Central America west of Panama Canal, Haiti, and Dominican Republic)
Listed in Order of Preference
A. Artemether-lumefantrine (Coartem®)5, 6(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: 1 dose BID
B. Atovaquone-proguanil (MalaroneTM)5, 7 (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®)5, 6(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: 1 dose BID
B. Atovaquone-proguanil (MalaroneTM)5,7 (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
C. Quinine sulfate8 plus doxycycline9, tetracycline9, or clindamycin10
Quinine sulfate: 542 mg base (650 mg salt) po TID x 3 or 7 days8
Doxycycline: 100 mg po BID x 7 days
Tetracycline: 250 mg po QID x 7 days
Clindamycin: 20 mg/kg/day po divided TID x 7 days
D. Mefloquine11
Dose 1: 684 mg base (750 mg salt) po
Dose 2 at 6 to 12 h: 456 mg base (500 mg salt) po
C. Quinine sulfate8plus doxycycline9, tetracycline9, or clindamycin10
Quinine sulfate: 8.3 mg base/kg (10 mg salt/kg) po TID x 3 or 7 days8 Doxycycline: 2.2 mg/kg po BID x 7 days
Tetracycline: 25 mg/kg/day po divided QID x 7 days
Clindamycin: 20 mg /kg/day po divided TID x 7 days
D. Mefloquine11
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
Chloroquine sensitive12
(Central America west of Panama Canal, Haiti, and Dominican Republic)
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; or
Hydroxychloroquine (PlaquenilTM 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
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 (PlaquenilTM 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
1 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, IV=intravenous, tab(s)=tablet(s).
2 If an antimalarial taken for chemoprophylaxis, a different drug should be used for treatment.
3 Option A preferred, Options B and C adequate alternatives and should be used if more readily available than Option A. Option D should be used only if other options not available.
4 Not to exceed adult dose.
5 Administer with food to improve absorption
6 Artemether-lumefantrine can be used in pregnancy. Not for infants <5 kg or women breastfeeding infants <5 kg.
7 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.
8 Quinine to be given for 3 days, except for infections acquired in Southeast Asia where 7 days of treatment required. Quinine available in the US has 324 mg (salt) per capsule; therefore, 2 capsules for adult dosing. Pediatric dosing may need compounding pharmacy.
9 Doxycycline or tetracycline combined with quinine preferred due to more efficacy data, but not recommended during pregnancy or in children <8 years old unless no other options and benefits outweigh risks.
10 Clindamycin with quinine preferred option for pregnant women and children <8 years old.
11 Mefloquine not recommended for infections acquired in Southeast Asia due to drug resistance. Not recommended if other options available or in patients with neuropsychiatric history.
12 Regimens used to treat chloroquine-resistant P. falciparum infections may be used if chloroquine and hydroxychloroquine not available.
Table 2. Uncomplicated malaria: P. vivax or P. ovale 1, 2
Download PDF version of Treatment Tables.
Drug Susceptibility
(Based on where acquired)
Recommended Adult Regimens
(BOTH acute and antirelapse treatments recommended)
Recommended Pediatric Regimens3
(BOTH acute and antirelapse treatments recommended)
Chloroquine sensitive
(All malaria- endemic regions except Papua New Guinea and Indonesia)
Acute treatment4:
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; 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
AND
Antirelapse treatment5:
Primaquine phosphate6,7,8
30 mg base (52.6 mg salt) po qd x 14 days; or
Tafenoquine (Krintafel™)6,7,9
300 mg po x 1 dose
Acute treatment4:
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: 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
AND
Antirelapse treatment5: Primaquine phosphate6,7,8
0.5 mg/kg base (0.8 mg/kg salt) po qd x 14 days; or
Tafenoquine (Krintafel™)6,7,9
300 mg po x 1 dose, only for patients ≥16 years old
Chloroquine resistant
(Papua New Guinea and Indonesia)
Acute treatment (listed in order of preference):
A. Artemether-lumefantrine (Coartem®)10
(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: 1 dose BID
B. Atovaquone-proguanil (Malarone™)11
(Adult tab: 250 mg atovaquone and 100 mg proguanil)
4 adult tabs po QD x 3 days
Acute treatment (listed in order of preference):
A. Artemether-lumefantrine (Coartem®)10
(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: 1 dose BID
B. Atovaquone-proguanil (Malarone™)11
(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
C. Quinine sulfate12 plus doxycycline13, tetracycline13, or clindamycin14
Quinine sulfate: 542 mg base (650 mg salt) po TID x 3 days
Doxycycline: 100 mg po BID x 7 days
Tetracycline: 250 mg po QID x 7 days
Clindamycin: 20 mg/kg/day po divided TID x 7 days
D. Mefloquine15
Dose 1: 684 mg base (750 mg salt) po
Dose 2 at 6 to 12 h: 456 mg base (500 mg salt) po
AND
Antirelapse treatment16:
Primaquine phosphate17,18,19
30 mg base (52.6 mg salt) po qd x 14 days
C. Quinine sulfate12 plus doxycycline13, tetracycline13, or clindamycin14
Quinine sulfate: 8.3 mg base/kg (10 mg salt/kg) po TID x 3 days
Doxycycline: 2.2 mg/kg po q12 h x 7 days
Tetracycline: 25 mg/kg/day po divided QID x 7 days
Clindamycin: 20 mg /kg/day po divided TID x 7 days
D. Mefloquine15
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
AND
Antirelapse treatment16:
Primaquine phosphate17,18,19
0.5 mg/kg base (0.8 mg/kg salt) po qd x 14 days
1 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, IV=intravenous, tab(s)=tablet(s).
2 If an antimalarial taken for chemoprophylaxis, a different drug should be used for treatment.
3 Not to exceed adult dose.
4 Regimens used to treat chloroquine-resistant P. vivax infections may be used if chloroquine and hydroxychloroquine not available.
5 Either option for antirelapse treatment recommended if chloroquine or hydroxychloroquine used for acute treatment. If regimens other than either chloroquine or hydroxychloroquine used for acute treatment, primaquine is the only option for antirelapse treatment.
6 Primaquine and tafenoquine associated with hemolytic anemia in those with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Prior to use, quantitative G6PD testing needed to confirm normal activity. For those with intermediate G6PD deficiency, weekly primaquine may be used (45 mg per week) for 8 weeks with close monitoring for hemolysis. Those with G6PD deficiency may be given chloroquine 300 mg base (500mg salt) po weekly for 1 year from acute infection to prevent relapses.
7 Primaquine and tafenoquine must not be used during pregnancy; pregnant patients with P. vivax and P. ovale infections should receive chloroquine 300 mg base (500mg salt) po weekly after acute treatment for the remainder of pregnancy. After delivery, patients with normal G6PD activity can be given primaquine or tafenoquine depending on breastfeeding, or continue with chloroquine prophylaxis for a total of 1 year from acute infection. Primaquine and tafenoquine can be used during breastfeeding if infant found to also have normal G6PD activity.
8 Dose of primaquine in patients ≥70 kg should be adjusted to a total dose of 6 mg/kg, divided into doses of 30 mg per day.
9 Tafenoquine can only be used if chloroquine or hydroxychloroquine administered for acute treatment due to limited data on efficacy when used in combination with other regimens.
10 Artemether-lumefantrine can be used in pregnancy. Not for infants <5 kg or women breastfeeding infants <5 kg.
11 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.
12 Quinine available in the US has 324 mg (salt) per capsule; therefore, 2 capsules for adult dosing. Pediatric dosing may need compounding pharmacy.
13 Doxycycline or tetracycline combined with quinine preferred due to more efficacy data, but not recommended during pregnancy or in children <8 years old unless no other options and benefits outweigh risks.
14 Clindamycin with quinine preferred option for pregnant women and children <8 years old.
15 Use only if no other options available. Not for use in patients with neuropsychiatric history.
16 Primaquine is the only option if regimens other than either chloroquine or hydroxychloroquine used for treatment of acute infection.
17 Primaquine associated with hemolytic anemia in those with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Prior to use, quantitative G6PD testing needed to confirm normal activity. For those with intermediate G6PD deficiency, weekly primaquine may be considered (45 mg per week) for 8 weeks with close monitoring for hemolysis. Those with G6PD deficiency may be given chloroquine 300 mg (base) po weekly for 1 year from acute infection to prevent relapses.
18 Primaquine must not be used during pregnancy; pregnant patients with P. vivax and P. ovale infections should receive chloroquine 300 mg (base) po weekly after acute treatment for the remainder of pregnancy. After delivery, patients with normal G6PD activity can be given primaquine depending on breastfeeding or continue with chloroquine prophylaxis for a total of 1 year from acute infection. Primaquine can be used during breastfeeding if infant found to also have normal G6PD activity.
19 Dose of primaquine in patients ≥70 kg should be adjusted to a total dose of 6 mg/kg, divided into doses of 30 mg per day.
Table 3. Uncomplicated malaria: P. malariae or P. knowlesi 1,2
Download PDF version of Treatment Tables.
Drug Susceptibility
(Based on where acquired)
Recommended Adult Regimens
Recommended Pediatric Regimens3
Chloroquine sensitive
(All malaria- endemic regions, no known resistance)
A. Chloroquine phosphate (Aralen™ and generics)
Dose: 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
B. Artemether-lumefantrine (Coartem®)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: 1 dose BID
A. 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: 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
B. Artemether-lumefantrine (Coartem®)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: 1 dose BID
C. Atovaquone-proguanil (Malarone™)5
(Adult tab: 250 mg atovaquone and 100 mg proguanil)
4 adult tabs po QD x 3 days
C. Atovaquone-proguanil (Malarone™)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
D. Quinine sulfate6 plus doxycycline7, tetracycline7, or clindamycin8
Quinine sulfate: 542 mg base (650 mg salt) po TID x 3 days
Doxycycline: 100 mg po BID x 7 days
Tetracycline: 250 mg po QID x 7 days
Clindamycin: 20 mg/kg/day po divided TID x 7 days
E. Mefloquine9
Dose 1: 684 mg base (750 mg salt) po
Dose 2 at 6 to 12 h: 456 mg base (500 mg salt) po
D. Quinine sulfate6 plus doxycycline7, tetracycline7, or clindamycin8
Quinine sulfate: 8.3 mg base/kg (10 mg salt/kg) po TID x 3 days
Doxycycline: 2.2 mg/kg po BID x 7 days
Tetracycline: 25 mg/kg/day po divided QID x 7 days
Clindamycin: 20 mg /kg/day po divided TID x 7 days
E. Mefloquine9
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
1 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, IV=intravenous, tab(s)=tablet(s).
2 If an antimalarial taken for chemoprophylaxis, a different drug should be used for treatment.
3 Not to exceed adult dose.
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 US has 324 mg (salt) per capsule; therefore, 2 capsules for adult dosing. Pediatric dosing may need compounding pharmacy.
7 Doxycycline or tetracycline combined with quinine preferred due to more efficacy data, but not recommended during pregnancy or in children <8 years old unless no other options and benefits outweigh risks.
8 Clindamycin with quinine preferred option for pregnant women and children <8 years old.
9 Use only if no other options available. Not for use in patients with neuropsychiatric history.
Table 4. Uncomplicated malaria: Pregnant women1,2
Download PDF version of Treatment Tables.
Species and Drug Susceptibility
(Based on where acquired)
Recommended Adult Regimens
Chloroquine resistant3
P. falciparum (All malaria- endemic regions except Central America west of Panama Canal, Haiti, and Dominican Republic)
P. vivax or P. ovale (Papua New Guinea and Indonesia)
All trimesters: Artemether-lumefantrine (Coartem®)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: 1 dose BID
All trimesters: Quinine sulfate plus clindamycin
Quinine sulfate: 542 mg base (650 mg salt) po TID x 3 or 7 days5
Clindamycin: 20 mg/kg/day po divided TID x 7 days
If no other options, all trimesters: Mefloquine
Dose 1: 684 mg base (750 mg salt) po
Dose 2 at 6 to 12 h: 456 mg base (500 mg salt) po
AND if P. vivax or P.ovale:
Chloroquine 300 mg base (500 mg salt) weekly until delivery, then consider antirelapse treatment (Table 2 for options and dosing)
Antirelapse treatment with either primaquine or tafenoquine contraindicated during pregnancy
Chloroquine sensitive
P. falciparum (Central America west of Panama Canal, Haiti, and Dominican Republic)
P. vivax or P. ovale (All malaria-endemic regions except Papua New Guinea and Indonesia)
P. malariae or P. knowlesi
A. 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; 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
Options above for chloroquine-resistant malaria parasites
AND if P. vivax or P.ovale:
Chloroquine 300 mg base (500 mg salt) weekly until delivery, then consider antirelapse treatment (Table 2 for options and dosing)
Antirelapse treatment with either primaquine or tafenoquine contraindicated during pregnancy
1 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, IV=intravenous, tab(s)=tablet(s).
2 If an antimalarial taken for chemoprophylaxis, a different drug should be used for treatment.
3 Atovaquone-proguanil not listed due to insufficient data on its safety during pregnancy but may be considered if other treatment options not available or not tolerated, and benefits outweigh risks.
4 Artemether-lumefantrine can be used in all trimesters in pregnancy per WHO evidence review and policy.
5 Quinine to be given for 3 days for P. falciparum and P. vivax infections, except for P. falciparum infections acquired in Southeast Asia where 7 days of treatment required.
Table 5: Severe malaria1,2,3,4,5
Download PDF version of Treatment Tables.
Species and Drug Susceptibility
(Based on where acquired)
Recommended Adult Regimens & Recommended Pediatric Regimen
All species, drug susceptibility not relevant for acute treatment of severe malaria
If P. vivax or P. ovale infections, in addition to acute treatment listed here, antirelapse treatment needed (Table 2)
IV artesunate: Commercially available from major distributors.
1 dose=2.4 mg/kg
IV doses (3 in total) at 0, 12 and 24 hours
PLUS follow-on treatment below
If IV artesunate not readily available, give oral antimalarials while obtaining IV artesunate. When IV artesunate arrives, discontinue oral antimalarial and initiate IV treatment. Interim treatment options (Table 1 for dosing):
- Artemether-lumefantrine (Coartem®) (preferred); or
- Atovaquone-proguanil (Malarone™); or
- Quinine sulfate; or
- Mefloquine (only if no other options available)
If oral therapy not tolerated, consider administration via nasogastric (NG) tube or after an antiemetic.
Reassess parasite density at least 4 hours after the third dose:
Parasite density ≤1% and patient able to tolerate oral medications: Give a complete follow-on oral regimen. Options include (Table 1 for dosing):
- Artemether-lumefantrine (Coartem®) (preferred), or
- Atovaquone-proguanil (Malarone™), or
- Quinine plus doxycycline or, in children <8 years old and pregnant women, clindamycin, or
- Mefloquine (only if no other options available)
Parasite density >1%: Continue IV artesunate, same dose, QD up to 6 more days (for a total of 7 days of IV artesunate) until parasite density ≤1%. When parasite density ≤1%, give complete follow-on oral regimen (Table 1 for options and dosing).
Parasite density ≤1% but patient unable to take oral medication: Continue IV artesunate, same dose, QD up to 6 more days (for a total of 7 days of IV artesunate) until patient able to take oral therapy.
1 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, IV=intravenous, tab(s)=tablet(s).
2 If an antimalarial taken for chemoprophylaxis, a different drug should be used for treatment.
3 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, acute respiratory distress syndrome, circulatory shock, disseminated intravascular coagulation, acidosis, jaundice [plus at least one other sign]); and/or parasite density ≥5%. Information on how to estimate parasite density available at www.cdc.gov/dpdx.
4 Parasite density should be repeated every 12–24 hours until negative.
5 Exchange transfusion no longer recommended based on a systematic review of the literature and analysis of US malaria surveillance data showing no added benefit.
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