A 55-year-old man returns from Southeast Asia with 10-day history of fever, chills, severe headache, and jaundice. Blood film shows ring forms and rare triple infection of erythrocytes. Parasitemia is 8%. Serum creatinine 3.1 mg/dL. The appropriate treatment for severe falciparum malaria is:
- A Oral artemether-lumefantrine for 3 days
- B IV quinine + doxycycline for 7 days
- C IV artesunate (2.4 mg/kg at 0, 12, 24 hours, then daily) ✓
- D IM artemether 3.2 mg/kg loading dose, then 1.6 mg/kg daily
Explanation
IV artesunate is the WHO-recommended first-line treatment for severe falciparum malaria (AQUAMAT trial, 2010, showed artesunate reduces mortality by 22.5% vs. quinine in African children; SEAQUAMAT showed 34.7% reduction in Asian adults). Severe malaria criteria include parasitemia >5%, renal failure, jaundice, impaired consciousness, or shock. IV artesunate is given 2.4 mg/kg at 0, 12, and 24 hours, then daily. Oral artemether-lumefantrine is for uncomplicated malaria. IV quinine is now second-line. IM artemether has variable absorption and is less effective than IV artesunate.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.