This protocol covers the management of patients with suspected severe malaria presenting at a facility that cannot deliver complete treatment. Pre-referral antimalarial therapy is required before transferring the patient to a facility equipped for definitive care.

Clinical Scenario

The patient has suspected severe malaria, but the current setting cannot provide complete treatment. Referral to an appropriate facility is necessary. A pre-referral antimalarial dose must be given before or during transfer to bridge care and reduce the risk of deterioration en route.

Treatment Approach

Management centres on giving a pre-referral dose of artesunate, with specific alternative agents indicated when artesunate is not locally available. A separate formulation option exists for young children in settings where the standard parenteral agents cannot be given. The patient should be referred immediately for further care.

Full agent selection, dosing, and the complete decision algorithm are available in the structured protocol below.

References

Where complete treatment of severe malaria is not possible, but injections are available, adults and children should be given a single intramuscular dose of artesunate, and referred to an appropriate facility for further care.
Where intramuscular artesunate is not available, intramuscular artemether or, if that is not available, intramuscular quinine should be used.
Where intramuscular injection of artesunate is not available, children < 6 years should be treated with a single rectal dose (10mg/kg bw) of artesunate, and referred immediately to an appropriate facility for further care.
Rectal artesunate should not be used in older children and adults.

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Treatment of Suspected Severe Malaria When Complete Care Is Unavailable and Immediate Referral Is Required

References