Severe Malaria Treatment

baby doctor clinic malaria

Please refer to the full prescribing information and/or patient information supplied by the relevant marketing authorization holder for your country, as well as local policies and treatment guidelines as they may vary from country to country.

Refer to the WHO Management of Severe Malaria Handbook  (3rd edition) for in depth case management recommendations and guidelines

Parenteral antimalarial agents should be given for a minimum of 24 h, even if the patient can tolerate oral medication earlier. 

Parenteral artesunate:  

The recommended treatment for severe malaria.


  • Artesunate 2.4 mg/kg body weight (bw) administered intravenously (IV) or intramuscularly (IM) at the time of admission (time=0), then at 12h and 24 h, then once a day until the patient is able to take oral medication. 
  • Children weighing <20 kg should receive a higher dose of artesunate (3 mg/kg/dose) than larger children and adults (2.4 mg/kg/dose) to ensure an equivalent drug exposure.

Alternative treatment

If parenteral artesunate is not available, use artemether in preference to quinine for severe malaria as an alternative treatment. 



  • Artemether 3.2 mg/kg bw IM given on admission then 1.6mg/kg bw per day



  • Quinine dihydrochloride 20 mg salt/kg bw (loading dose) on admission, then 10 mg/kg bw every 8 h.

Note: Rapid intravenous administration of quinine is dangerous. Each dose of parenteral quinine must be administered as slow, rate-controlled infusion (usually diluted in 5% dextrose and infused over 4h)

Follow-on treatment

Complete treatment by giving a full course of effective, WHO recommended, artemisinin-based combination therapy (ACT) as soon as the patient is able to take oral medication (but not before the minimum 24 h of parenteral treatment). Add single dose primaquine in areas of low transmission. 

  • Artemether-lumefantrine
  • Artesunate/amodiaquine
  • Artesunate-mefloquine
  • Artesunate + sulfadoxine-pyrimethamine
  • Dihydroartemisinin-piperaquine

For follow-on treatment recommendations related to P. vivax, please visit the malaria species page.