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close this bookGuidelines for the Treatment of Malaria (WHO; 2006; 266 pages) View the PDF document
View the documentGlossary
View the documentAbbreviations
open this folder and view contents1. Introduction
View the document2. The clinical disease
open this folder and view contents3. Treatment objectives
open this folder and view contents4. Diagnosis of malaria
open this folder and view contents5. Resistance to antimalarial medicines9
open this folder and view contents6. Antimalarial treatment policy
open this folder and view contents7. Treatment of uncomplicated P. Falciparum malaria10
close this folder8. Treatment of severe falciparum malaria14
View the document8.1 Definition
View the document8.2 Treatment objectives
View the document8.3 Clinical assessment
View the document8.4 Specific antimalarial treatment
View the document8.5 Practical aspects of treatment
View the document8.6 Follow-on treatment
View the document8.7 Pre-referral treatment options16
View the document8.8 Adjunctive treatment
View the document8.9 Continuing supportive care
View the document8.10 Additional aspects of clinical management
View the document8.11 Treatment during pregnancy
View the document8.12 Management in epidemic situations
View the document8.13 Hyperparasitaemia18
open this folder and view contents9. Treatment of malaria caused by P. vivax, P. ovale or P. malariae19
View the document10. Mixed malaria infections
open this folder and view contents11. Complex emergencies and epidemics
open this folder and view contentsAnnexes

8.8 Adjunctive treatment

In an attempt to reduce the unacceptably high mortality of severe malaria, various adjunctive treatments for the complications of malaria have been evaluated in clinical trials. These are summarized in Table 7 and further information is given in sections 8.9 and 8.10.

Table 7. Immediate clinical management of severe manifestations and complications of falciparum malaria


Immediate managementa

Coma (cerebral malaria)

Maintain airway, place patient on his or her side, exclude other treatable causes of coma (e.g. hypoglycaemia, bacterial meningitis); avoid harmful ancillary treatment such as corticosteroids, heparin and adrenaline; intubate if necessary.


Administer tepid sponging, fanning, cooling blanket and antipyretic drugs.


Maintain airways; treat promptly with intravenous or rectal diazepam or intramuscular paraldehyde.

Hypoglycaemia (blood glucose concentration of <2.2 mmol/l; <40 mg/100ml)

Check blood glucose, correct hypoglycaemia and maintain with glucose-containing infusion.

Severe anaemia (haemoglobin <5 g/100ml or packed cell volume <15%)

Transfuse with screened fresh whole blood

Acute pulmonary oedemab

Prop patient up at an angle of 45o, give oxygen, give a diuretic, stop intravenous fluids, intubate and add positive end-expiratory pressure/continuous positive airway pressure in life-threatening hypoxaemia.

Acute renal failure

Exclude pre-renal causes, check fluid balance and urinary sodium; if in established renal failure add haemofiltration or haemodialysis, or if unavailable, peritoneal dialysis. The benefits of diuretics/dopamine in acute renal failure are not proven.

Spontaneous bleeding and coagulopathy

Transfuse with screened fresh whole blood (cryoprecipitate, fresh frozen plasma and platelets if available); give vitamin K injection.

Metabolic acidosis

Exclude or treat hypoglycaemia, hypovolaemia and septicaemia. If severe add haemofiltration or haemodialysis.


Suspect septicaemia, take blood for cultures; give parenteral antimicrobials, correct haemodynamic disturbances.


See section 8.14.


a It is assumed that appropriate antimalarial treatment will have been started in all cases.
b Prevent by avoiding excess hydration.


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