# Malaria (Uncomplicated) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: WHO Guidelines for Malaria 2023 · Primaquine phosphate tablets, film coated (sanofi-aventis U.S. LLC) US prescribing information, Indications and Usage, Contraindications, Warnings and Dosage and Administration (DailyMed SetID 1bfbf4ae-81b8-4160-a00d-6322aadd4b59) · KRINTAFEL (tafenoquine succinate) tablets US prescribing information, section 1 Indications and Usage, section 2 Dosage and Administration, section 4 Contraindications and section 5 Warnings and Precautions (DailyMed SetID 5cf989d5-36f5-4561-a30b-9fcb9deb6b6a) · Egyptian National Drug Formulary 2023 - Antimicrobial (mefloquine monograph) - Verified date: 2026-08 ## Verified against - WHO Guidelines for Malaria 2023 - Malaria - disease-level clinical article (malaria-uncomplicated-full.txt) - Primaquine phosphate tablets, film coated (sanofi-aventis U.S. LLC) US prescribing information, Indications and Usage, Contraindications, Warnings and Dosage and Administration (DailyMed SetID 1bfbf4ae-81b8-4160-a00d-6322aadd4b59) - KRINTAFEL (tafenoquine succinate) tablets US prescribing information, section 1 Indications and Usage, section 2 Dosage and Administration, section 4 Contraindications and section 5 Warnings and Precautions (DailyMed SetID 5cf989d5-36f5-4561-a30b-9fcb9deb6b6a) ## Treatment metadata - Artemether + Lumefantrine — 20 mg — oral.solid - Referral & safety-netting (no drug therapy) - Chloroquine — 155 mg — oral.solid - Mefloquine — 250 mg — oral.solid - Primaquine — oral.solid - Tafenoquine — 150 mg — oral.solid ## Complete treatment card ```text MALARIA (UNCOMPLICATED) Sources: WHO Guidelines for Malaria 2023 · Primaquine phosphate tablets, film coated (sanofi-aventis U.S. LLC) US prescribing information, Indications and Usage, Contraindications, Warnings and Dosage and Administration (DailyMed SetID 1bfbf4ae-81b8-4160-a00d-6322aadd4b59) · KRINTAFEL (tafenoquine succinate) tablets US prescribing information, section 1 Indications and Usage, section 2 Dosage and Administration, section 4 Contraindications and section 5 Warnings and Precautions (DailyMed SetID 5cf989d5-36f5-4561-a30b-9fcb9deb6b6a) · Egyptian National Drug Formulary 2023 - Antimicrobial (mefloquine monograph) Review status: REVIEWED against WHO Guidelines for Malaria 2023, Malaria - disease-level clinical article (malaria-uncomplicated-full.txt), Primaquine phosphate tablets, film coated (sanofi-aventis U.S. LLC) US prescribing information, Indications and Usage, Contraindications, Warnings and Dosage and Administration (DailyMed SetID 1bfbf4ae-81b8-4160-a00d-6322aadd4b59), KRINTAFEL (tafenoquine succinate) tablets US prescribing information, section 1 Indications and Usage, section 2 Dosage and Administration, section 4 Contraindications and section 5 Warnings and Precautions (DailyMed SetID 5cf989d5-36f5-4561-a30b-9fcb9deb6b6a) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Fever lasting seven days or more in someone living in or recently returned from an endemic area is highly suspicious for malaria [fever] - Adults may have headache, malaise, weakness, gastrointestinal upset, respiratory symptoms, and muscle aches [headache · malaise · muscle pain] - Severe cases can bring jaundice, confusion, seizures, and dark urine [confusion · jaundice · seizures] - Children more often have non-specific or gastrointestinal symptoms such as lethargy, nausea, vomiting, and abdominal cramps [abdominal pain · lethargy · nausea · vomiting] SIGNS - what you find (2) - Children with severe malaria have seizures more often than adults, in 60 to 80% of cases [seizures] - Unlike adults, children with malaria more often get an enlarged liver and spleen plus severe anemia, without major organ dysfunction [anaemia · hepatomegaly] TESTS (4) - Anemia affects about 78% of children with malaria but only 29% of adults; thrombocytopenia is seen in 60 to 70% of all cases - Giemsa-stained thick and thin blood smears are the gold standard for diagnosing malaria - A single negative smear does not rule out malaria - it should be repeated at 12 and 24 hours if suspicion stays high - Rapid antigen tests approach 100% sensitivity but only detect P. falciparum and cannot measure parasite burden IF NOT THIS - what else fits (3) - In a review of febrile travelers, 77% had malaria, 18% had bacterial enteric fever, and 5% had another infection - Fever with marked drowsiness or seizures should raise concern for viral or bacterial meningitis or meningoencephalitis - In one tropical study of febrile children, 10.5% had malaria versus 62% with a respiratory infection Source StatPearls "Malaria" - disease-level clinical article Status traced to the source above Rx: Main treatment | Chloroquine-resistant falciparum when an artemisinin combination is not available | Radical cure - clears liver hypnozoites in P. vivax or P. ovale only | One-dose radical cure instead of 14 days of primaquine - age 16+, chloroquine only MAIN TREATMENT - choose one 1. ARTEMETHER + LUMEFANTRINE [1st line] Adult 4 tablets at 0h, 4 tablets at 8h, then 4 tablets twice daily on days 2 and 3 (total 24 tablets over 3 days) x 3 days (6 doses total) Peds Dosed by weight band: 5-14 kg: 1 tab per dose; 15-24 kg: 2 tabs per dose; 25-34 kg: 3 tabs per dose; >=35 kg: adult dose (4 tabs) at 0, 8, 24, 36, 48, 60 hours Source WHO Guidelines for Malaria 2023 Why First-line Artemisinin-based Combination Therapy (ACT) recommended by WHO and registered in Egypt Caution Monitor for symptoms of severe malaria (jaundice, confusion, severe anaemia, respiratory distress) requiring immediate hospital admission. Take each dose with fatty food or milk to ensure adequate lumefantrine absorption. Egypt MALARI-CO 10 TABS. MULTI-APEX 100.00 EGP (10.00/unit) -> ? strength differs 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Malaria - disease-level clinical article (malaria-uncomplicated-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Treatment-naive patients starting active antimalarial therapy should be admitted for at least 24 hours to monitor dosing and parasitemia trend, not managed purely as outpatients. 3. CHLOROQUINE [2nd line] Adult Chloroquine phosphate 600 mg base (= 1000 mg salt) loading dose, then 300 mg base (= 500 mg salt) at 6, 24 and 48 hours (total 1500 mg base over 3 days) x 3 days Peds 10 mg/kg base initially, 5 mg/kg at 6h, 24h, 48h (total 25 mg/kg base over 3 days) Source Malaria - disease-level clinical article (malaria-uncomplicated-full.txt), reporting the 2019 CDC regimens: "chloroquine phosphate 600 mg (pediatric: 10 mg/kg) loading dose, followed by 300 mg (pediatric: 5 mg/kg) at 6, 24, 48 hours", with the base-and-salt equivalence from the same article: "00 hours: 600 mg base (= 1000 mg salt) 06 hours: 300 mg base (= 500 mg salt)". The 620 mg and 310 mg figures in the same passage belong to hydroxychloroquine, a different medicine. Why Reserved for confirmed non-falciparum malaria (P. vivax/ovale); P. falciparum is universally chloroquine-resistant. Caution Only use for P. vivax/ovale; P. falciparum is widely resistant to chloroquine. Irreversible retinopathy with prolonged use; acute overdose causes fatal arrhythmias. Egypt MALARQUINE 100MG 10 TAB. EL NASR 0.70 EGP (0.07/unit) -> ? strength differs MALARQUINE 250MG 20 TAB. EL NASR 3.00 EGP (0.15/unit) -> ? strength differs ALEXOQUINE 250MG 10 TAB. ALEXANDRIA 10.00 EGP (1.00/unit) -> ? strength differs CHLOROQUINE PHOSPHATE 250 MG 20 TABS. MUP 20.00 EGP (1.00/unit) -> ? strength differs CHLOROQUINE-RESISTANT FALCIPARUM WHEN AN ARTEMISININ COMBINATION IS NOT AVAILABLE 4. MEFLOQUINE [2nd line] Adult 750 mg by mouth to start, then 500 mg 6 to 12 hours later - two doses on one day Peds Children: 15 mg/kg for the first dose, never more than 750 mg, then 10 mg/kg (never more than 500 mg) 6 to 12 hours later. The formulary says to give it together with another antimalarial in children. Source Egyptian National Drug Formulary 2023 - Antimicrobial (mefloquine monograph) - verbatim: "-Uncomplicated malaria, treatment: 750 mg as initial dose, followed 6 to 12 hours later by 500 mg." Why It is the one alternative in the article's chloroquine-resistant list that is a complete regimen by itself and is actually sold in Egypt; the quinine-based options need a partner drug the country does not stock. It stays behind artemether-lumefantrine because of its effects on mood and sleep, and because supply here rests on a single imported product. Caution Do not give it to anyone with epilepsy, depression, anxiety disorder, psychosis or any other major psychiatric history. It carries a boxed warning for effects on mood, sleep and behaviour that can outlast the tablets - warn the patient and the family what to watch for. It can disturb heart rhythm, so avoid it alongside other drugs that do the same, and be careful in known heart disease. Artemether-lumefantrine remains the preferred treatment; mefloquine is for when that is unavailable. Any patient who cannot keep tablets down, or who has confusion, jaundice or dark urine, has severe malaria and needs hospital care, not this. Egypt APO-MEFLOQUINE 250 MG 8 TAB. APOTEX INC. C... 65.00 EGP (8.12/unit) RADICAL CURE - CLEARS LIVER HYPNOZOITES IN P. VIVAX OR P. OVALE ONLY - give alongside 5. PRIMAQUINE [add-on - not a substitute] Adult Given alongside chloroquine, not instead of it. The US label's adult dose is 1 tablet - 26.3 mg, equal to a 15 mg base dose - taken once a day across a 14-day course, to clear the liver-stage parasites; it may be taken with or without food, though taking it with food may cut down on GI side effects. StatPearls' malaria article prints a heavier daily figure across the same 14 days: 30 mg if dosing an adult, 0.5 mg/kg for a child - and both are shown here because they genuinely differ; the licensed label's own schedule leads here. - Fourteen days, and the course is what prevents the relapse rather than what treats the attack. US label verbatim: "daily for 14 days", and the drug is "recommended only for the radical cure of vivax malaria, the prevention of relapse in vivax malaria, or following the termination of chloroquine phosphate suppressive therapy in an area where vivax malaria is endemic." Peds No paediatric dose is written here, deliberately. The US label states that safety and effectiveness in children have not been established. StatPearls' malaria article does give a child's figure - 0.5 mg/kg daily for the same 14 days - but it sits outside the label, and the drug's main hazard is haemolysis driven by G6PD status. A child with P. vivax belongs with a fever hospital that can test G6PD and monitor the blood count. Source Primaquine phosphate tablets, film coated (sanofi-aventis U.S. LLC) US prescribing information, Indications and Usage, Contraindications, Warnings and Dosage and Administration (DailyMed SetID 1bfbf4ae-81b8-4160-a00d-6322aadd4b59) Why StatPearls' malaria article names primaquine as the hypnozoiticidal drug added for P. vivax or P. ovale infection, clearing the parasites dormant in the liver and preventing the relapses that follow. It places the drug in the regimen: in a chloroquine-sensitive region, uncomplicated P. vivax or P. ovale is treated with chloroquine phosphate or hydroxychloroquine, plus a radical-cure drug - either 14 days of primaquine phosphate at 30 mg a day for an adult (0.5 mg/kg for a child), or tafenoquine as a single 300 mg dose. The US label's licensed use is the radical cure - preventing relapse - of vivax malaria. The card carried only the blood-stage drugs, so a returning traveller or a patient from Sudan or Yemen with P. vivax would have had the attack treated while the liver stage was left untouched. Egypt has no registered primaquine product, so no local brand or price can be shown; the row exists so a regimen started abroad or at a fever hospital can be recognised and completed. Caution RED FLAG - G6PD must be tested before the first tablet, not after. US label verbatim: "Due to the risk of hemolytic anemia in patients with G6PD deficiency, G6PD testing must be performed before using primaquine. Before initiating treatment, obtain baseline hemoglobin and hematocrit." The label names the regions: "Areas of high prevalence of G6PD deficiency are Africa, Southern Europe, Mediterranean region, Middle East, South- East Asia, and Oceania." Egypt sits inside that list. The label gives no numeric enzyme- activity threshold - it contraindicates "Severe glucose-6-phosphate dehydrogenase (G6PD) deficiency" and, for mild to moderate deficiency or unknown status, requires a risk- benefit decision with "baseline hematocrit and hemoglobin" and "close hematological monitoring (e.g., at day 3 and 8)". CONTRAINDICATED OUTRIGHT in three groups: severe G6PD deficiency, pregnancy, and breastfeeding when the infant is known to be G6PD deficient or their G6PD status is unknown - all per the US label. StatPearls' malaria article bars the same two groups on its own reasoning: primaquine is not to be given in pregnancy, since it affects the fetus, and is not to be given in G6PD deficiency, since it triggers haemolysis - seen on the blood film as bite cells and Heinz bodies. Teach the patient what haemolysis looks like before they leave. US label verbatim: "Warn patients to discontinue the use of Primaquine phosphate Tablets promptly if signs suggestive of hemolytic anemia occur (such as darkening of the urine, pale skin, shortness of breath, dizziness, and fatigue) and to contact their healthcare professional immediately." Contraception is part of the prescription. US label verbatim: "Advise sexually active females of childbearing potential to use effective contraception (methods that result in less than 1% pregnancy rates) when using primaquine and for 6 months after stopping treatment). Advise treated males whose partners may become pregnant, to use a condom while on treatment and for 3 months after stopping treatment with primaquine." A pregnancy test comes first: "Sexually active females of reproductive potential should have a pregnancy test prior to starting treatment with primaquine." Methaemoglobinaemia and leukopenia are the other two blood risks. US label verbatim: "Advise all patients to seek immediate medical attention if signs of methemoglobinemia occur such as bluish lips or nails." and "Discontinue the use of primaquine promptly if there is a sudden decrease in leukocyte count." It does not treat the attack. The blood-stage drug on this card does that; primaquine is added to it. Giving primaquine alone to a febrile patient with parasitaemia treats nothing that is making them ill. Egypt no Egyptian brand matched - prescribe by generic name ONE-DOSE RADICAL CURE INSTEAD OF 14 DAYS OF PRIMAQUINE - AGE 16+, CHLOROQUINE ONLY - give alongside 6. TAFENOQUINE [add-on - not a substitute] Adult Taken as a single dose, with food, together with chloroquine. The US label's adult dose (16 and older) is 300 mg total, given as two 150 mg tablets swallowed at the same time; it is co-administered on the first day or the second day of the chloroquine course being given for acute P. vivax infection. It should be taken with food to boost absorption; swallow the tablets whole - they must not be snapped, crushed or chewed. If it comes back up within 1 hour of the dose, give one repeat dose; re-dosing should not go beyond that single repeat. StatPearls' malaria article gives the same single 300 mg figure. - A single dose. That is the whole point of it beside the 14-day primaquine course, which patients often stop early once the fever has gone. Peds Age restriction: minimum 192 months (Not licensed below 16 years. The US label states safety and effectiveness are established from age 16 and have not been established below that age. StatPearls' malaria article agrees, setting the same cutoff at 16.) Source KRINTAFEL (tafenoquine succinate) tablets US prescribing information, section 1 Indications and Usage, section 2 Dosage and Administration, section 4 Contraindications and section 5 Warnings and Precautions (DailyMed SetID 5cf989d5-36f5-4561-a30b-9fcb9deb6b6a) Why StatPearls' malaria article names tafenoquine alongside primaquine: for uncomplicated P. vivax or P. ovale in a chloroquine-sensitive region, treatment is chloroquine phosphate or hydroxychloroquine plus a radical-cure drug - either 14 days of primaquine at 30 mg a day for an adult (0.5 mg/kg for a child), or a single 300 mg dose of tafenoquine, the same dose used in children over 16. The US label's licensed use is radical cure (preventing relapse) of P. vivax malaria in patients 16 and older who are also on chloroquine for the acute infection. It sits behind primaquine because its G6PD screening requirement is stricter, not because it works less well. Egypt has no registered tafenoquine product, so no local brand or price can be shown. Caution RED FLAG - G6PD deficiency is an absolute bar here, not a caution. US label verbatim, contraindications: "Patients with G6PD deficiency or unknown G6PD status due to the risk of hemolytic anemia." Testing is mandatory: "All patients must be tested for glucose-6-phosphate dehydrogenase (G6PD) deficiency prior to prescribing KRINTAFEL." This is the difference from primaquine, where a mild deficiency can still be weighed up - with tafenoquine there is nothing to weigh, and an unavailable G6PD test is itself a contraindication. The label's only number is the trial threshold, verbatim: "Patients were excluded from clinical trials of KRINTAFEL if they had a G6PD enzyme activity level <70% of the site median value for G6PD normal activity". A 15-day half-life means a bad reaction does not stop when the tablet is swallowed. US label verbatim: "Due to the long half-life of KRINTAFEL (approximately 15 days), signs or symptoms of hypersensitivity adverse reactions that may occur could be delayed in onset and/or duration." Nothing can be done to take the dose back. Pregnancy and breastfeeding. US label verbatim: "The use of KRINTAFEL during pregnancy may cause hemolytic anemia in a G6PD-deficient fetus. Even if a pregnant woman has normal levels of G6PD, the fetus could be G6PD deficient. Advise females of reproductive potential that treatment with KRINTAFEL during pregnancy is not recommended and to avoid pregnancy or use effective contraception for 3 months after the dose of KRINTAFEL." It is contraindicated in "Breastfeeding by a lactating woman when the infant is found to be G6PD deficient or if the G6PD status of the infant is unknown", and where the infant is G6PD-deficient or untested the label says not to breastfeed "for 3 months after the dose". A pregnancy test is recommended first. Chloroquine is the only partner drug the label allows. US label verbatim: "Concomitant use of KRINTAFEL with antimalarials other than chloroquine is not recommended because of the risk of recurrence of P. vivax malaria." It also states "KRINTAFEL is NOT indicated for the treatment of acute P. vivax malaria." Methaemoglobinaemia. US label verbatim: "Asymptomatic elevations in methemoglobin have been observed in the clinical trials of KRINTAFEL. Institute appropriate therapy if signs or symptoms of methemoglobinemia occur. Carefully monitor individuals with nicotinamide adenine dinucleotide (NADH)-dependent methemoglobin reductase deficiency." Egypt no Egyptian brand matched - prescribe by generic name Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)