What are the current guidelines for the treatment of uncomplicated malaria in adults and children?

Treatment of uncomplicated malaria in adults and children depends on the Plasmodium species, severity, drug tolerability, and resistance patterns.

For uncomplicated falciparum malaria, the preferred treatment is artemisinin combination therapy (ACT). If ACT is unavailable, atovaquone-proguanil or quinine plus doxycycline (not for children under 12 years) may be used.

For uncomplicated non-falciparum malaria (P. malariae, P. ovale, P. knowlesi, and most cases of P. vivax), chloroquine may be used, but this depends on local resistance and tolerance patterns.

Primaquine is used to eradicate hypnozoites in P. vivax and P. ovale infections but requires prior screening for G6PD deficiency due to risk of haemolysis and is contraindicated in pregnancy and breastfeeding.

All patients with uncomplicated malaria should be assessed for the need for admission; children, pregnant women, and older adults are generally admitted due to higher risk of complications, while some adults with uncomplicated non-falciparum malaria may be managed as outpatients if close monitoring is available.

Early diagnosis and appropriate treatment are critical as malaria can rapidly progress to severe disease.

Neurological and psychiatric side effects may occur with antimalarial drugs, and artesunate-type drugs are better tolerated in pregnancy than quinine.