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Severe Falciparum Malaria — RACP Adult Medicine MCQ

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EasyInfectious DiseasesSevere Falciparum MalariaRACP Adult Medicine

A 30-year-old man presents with jaundice after returning from Papua New Guinea. Thick and thin blood films show ring-form trophozoites of Plasmodium falciparum with a parasitaemia of 8%. He has a GCS of 14 and his creatinine is 200 µmol/L. What is the first-line treatment for severe falciparum malaria?

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Correct answer: A — IV artesunate

Severe falciparum malaria (parasitaemia >2%, cerebral involvement, renal failure, ARDS, severe anaemia, acidosis, hypoglycaemia, or shock) is treated with IV artesunate as first-line therapy. The SEAQUAMAT and AQUAMAT trials showed IV artesunate reduces mortality by 35% compared to IV quinine. Artesunate 2.4 mg/kg IV at 0, 12, 24, and then 24-hourly until oral therapy can be tolerated. Switch to oral artemether/lumefantrine (Riamet) to complete treatment. IV quinine is the alternative if artesunate is unavailable.

Reference: eTG – 2025 – Antibiotic Guidelines; WHO – 2022 – Malaria Treatment Guidelines