Uncomplicated falciparum malaria — DTM&H MCQ

Correct answer: B — Oral artemether-lumefantrine

Oral artemether-lumefantrine (B) is correct because this is uncomplicated falciparum malaria: the patient is alert, has normal renal function, and parasitaemia is 0.8 percent, well below the 2 percent threshold that mandates parenteral therapy. UK guidance states that uncomplicated P. falciparum malaria should be treated with an artemisinin combination therapy, with artemether-lumefantrine as the drug of choice. This achieves rapid parasite clearance and reduces resistance selection compared with monotherapy, and oral treatment is appropriate since the patient can swallow and retain tablets with no severity or organ dysfunction criteria requiring intravenous treatment. Why the other options are wrong: E. Oral chloroquine: Chloroquine resistance in P. falciparum is near universal in Ghana and most malaria endemic regions, so chloroquine has no role in falciparum treatment; it remains useful only for chloroquine sensitive non-falciparum species. D. Intravenous quinine: This is reserved for severe or complicated malaria, or when the patient cannot take oral therapy; here parasitaemia is well under 2 percent and there is no organ dysfunction, so oral ACT is sufficient and quinine's side effect and monitoring burden is unwarranted. A. Doxycycline monotherapy: Doxycycline is used for malaria chemoprophylaxis and as an adjunct in some regimens, but it is not recommended as monotherapy for treating an established falciparum infection. C. Primaquine monotherapy: Primaquine targets liver stage hypnozoites of P. vivax and P. ovale for radical cure and has no role against blood stage P. falciparum, which has no hypnozoite stage. Key point: Uncomplicated falciparum malaria (no severe features, parasitaemia under 2 percent, tolerating oral intake) is treated with an oral artemisinin combination therapy such as artemether-lumefantrine, reserving intravenous artesunate or quinine for severe or complicated disease.

Reference: UK malaria treatment guidelines 2016 (PHE/British Infection Association, Journal of Infection; recommendations remain current UK standard), Lalloo DG et al: uncomplicated P. falciparum malaria treated with an artemisinin combination therapy, artemether-lumefantrine as drug of choice; intravenous therapy reserved for parasitaemia >2%, inability to tolerate oral treatment, or severe disease criteria. https://www.journalofinfection.com/article/S0163-4453(16)00047-5/fulltext