If you have a fever after travel or live where malaria is common, quick diagnosis and the right drug matter. Malaria is diagnosed by microscopy or rapid diagnostic tests (RDTs). Treating without confirmation is rarely a good idea unless severe disease is likely and testing is unavailable.
First-line treatment for uncomplicated Plasmodium falciparum in most regions is an artemisinin-based combination therapy (ACT). Common ACTs include artemether-lumefantrine, artesunate-amodiaquine, and dihydroartemisinin–piperaquine. ACTs clear blood parasites fast and lower the chance of resistance when two effective drugs are combined. The World Health Organization recommends ACTs as the standard for falciparum infections where resistance to older drugs like chloroquine is present.
For non-falciparum species such as Plasmodium vivax or Plasmodium ovale you still treat the blood stage with an effective ACT or chloroquine where sensitivity remains. To stop relapses from dormant liver forms (hypnozoites) you need a radical cure: primaquine given for 14 days or a single dose of tafenoquine for certain patients. Always test for G6PD deficiency before giving these drugs because they can cause severe hemolysis in deficient patients.
Severe malaria needs urgent hospital care. Intravenous artesunate is the preferred treatment for severe disease and reduces mortality versus older options. After initial IV therapy, switch to a full course of an effective oral ACT once the patient can take pills. Supportive care — fluids, oxygen, treating seizures and low blood sugar — makes a big difference.
Prophylaxis choices depend on destination and personal factors. Atovaquone–proguanil (Malarone) is well tolerated and used for short trips. Doxycycline is cheap and effective but causes sun sensitivity and isn’t advised in young children or pregnant women. Mefloquine is an alternative but can cause neuropsychiatric side effects in some people. Match your preventive drug to the resistance map and your health status.
Pregnancy and young children need special care. In pregnancy, certain drugs are unsafe; for example, doxycycline and tafenoquine are avoided. Pregnant women with malaria should get treatment recommended by local guidelines, often including ACTs in the second and third trimesters, and close follow up.
Choosing the right malaria treatment depends on the species, severity, local drug resistance, allergies, pregnancy status, and whether you can complete the course. Tell your clinician about recent travel, previous malaria, and other medicines you take. If you’re buying medicine abroad, check that the pharmacy is legitimate and the package shows an active ingredient and batch number. Never use partial doses or leftover pills. If symptoms return after treatment, get retested—relapse or drug failure is possible. Keep a copy of your treatment and follow-up plan, especially when traveling in remote areas.
Ask for local guidelines and a clear follow-up plan before leaving care.
Explore the top 9 alternatives to Hydroxychloroquine in 2025, offering new hope for treating autoimmune diseases and malaria. This guide provides an in-depth look at each option, including their pros and cons, to help patients and healthcare providers make informed decisions.