Successful malaria elimination depends on early diagnosis and prompt treatment of active malaria infections with efficacious antimalarial drugs. Rapid removal of malaria parasites from the person’s bloodstream will prevent the infection developing into severe malaria and will minimise the risk of transmission to others. Malaria-endemic countries have national malaria treatment policies that specify drugs for treatment of uncomplicated and severe malaria, malaria in pregnancy and what to do if first-line treatment fails.
As malaria parasites develop resistance to existing drugs, new antimalarials with different modes of action need to be introduced. For Plasmodium falciparum, using two or more drugs with different modes of action in combination is now recommended to provide adequate cure rates and delay the development of resistance.
Find out more about our work to monitor and tackle resistance to antimalarial drugs and diagnostics.
Artemisinin-based combination therapy (ACT)
Artemisinin-based combination therapy (ACT) is recommended for the treatment of P. falciparum malaria. Fast-acting artemisinin derivatives, such as dihydroartemisinin, artesunate and artemether, are combined with a drug with a different mode of action. Companion drugs include lumefantrine, mefloquine, amodiaquine, sulfadoxine-pyrimethamine, piperaquine and chlorproguanil/dapsone. A co-formulated drug is one in which two different drugs are combined in one tablet; this is important to ensure both drugs are used.
The benefits of ACTs are their high efficacy, fast action and the reduced likelihood of resistance developing. In order to make best use of them, it is critical to address issues of delivery, access and cost.
Chloroquine, primaquine and tafenoquine
Chloroquine is still the first-line treatment for P. vivax and P. ovale, while primaquine can be used to treat liver stage parasites of P. vivax in areas of low malaria transmission, if adherence is guaranteed. Tafenoquine is now also becoming available for treatment of P. vivax malaria.
For the latest guidance on malaria treatment with ACTs and other antimalarial drugs, see the WHO Malaria Guidelines.