Table 2.

WHO recommendations for the treatment of malaria

Type of malaria infection	1st line treatment	2nd line treatments
Uncomplicated falciparum malaria	Artemisinin-based combination therapy* (ACT)**	1) Alternative ACT known to be effective in that region 2) Artesunate plus doxycycline or tetracycline or clindamycin 3) Quinine plus doxycycline or tetracycline or clindamycin
Severe falciparum malaria	Intravenous artesunate	Intravenous artemether or intravenous quinine if intravenous artesunate is not available
vivax malaria	Chloroquine plus primaquine*** for quinine-sensitive strains	ACT plus primaquine for quinine-resistant strains
ovale malaria	Chloroquine plus primaquine
malariae malaria	Chloroquine

ACTs recommended include artemether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine, and artesunate plus sulfadoxine-pyrimethamine

*For travellers returning to non-endemic countries atovaquone-proguanil, artemether-lumefantrine or quinine plus doxycycline or quinine plus clindamycin is recommended

**ACTs are unavailable in Canada and the CATMET recommended first-choice therapy for uncomplicated falciparum malaria is oral atovaquone-proguanil (Malarone™)

***Primaquine required for clearance of liver-stage hypnozoites seen only in vivax and ovale

ACT = artemisinin-based combination therapy; CATMET = Committee to Advise on Tropical Medicine and Travel

Adapted from WHO guidelines for the treatment of malaria22