An advertisement for quinine as a<unk>  treatment from 1927.<unk>  is treated with antimalarial medications; the ones used depends on the type and severity of the disease. While medications against fever are commonly used, their effects on outcomes are not clear. Providing free antimalarial drugs to households may reduce childhood deaths when used appropriately. Programmes which presumptively treat all causes of fever with antimalarial drugs may lead to overuse of antimalarials and undertreat other causes of fever. Nevertheless, the use of<unk>  rapid-diagnostic kits can help to reduce over-usage of antimalarials. Uncomplicated<unk>  Simple or uncomplicated<unk>  may be treated with oral medications. Artemisinin drugs are effective and safe in treating uncomplicated<unk> . Artemisinin in combination with other antimalarials (known as artemisinin-combination therapy, or ACT) is about 90% effective when used to treat uncomplicated<unk> . The most effective treatment for P. falciparum infection is the use of ACT, which decreases resistance to any single drug component. Artemether-lumefantrine (six-dose regimen) is more effective than the artemether-lumefantrine (four-dose regimen) or other regimens not containing artemisinin derivatives in treating falciparum<unk> . Another recommended combination is dihydroartemisinin and piperaquine. Artemisinin-naphthoquine combination therapy showed promising results in treating falciparum<unk> . However, more research is needed to establish its efficacy as a reliable treatment. Artesunate plus mefloquine performs better than mefloquine alone in treating uncomplicated falciparum<unk>  in low transmission settings. Atovaquone-proguanil is effective against uncomplicated falciparum with a possible failure rate of 5% to 10%; the addition of artesunate may reduce failure rate. Azithromycin monotherapy or combination therapy has not shown effectiveness in treating plasmodium or vivax<unk> . Amodiaquine plus sulfadoxine-pyrimethamine may achieve less treatment failures when compared to sulfadoxine-pyrimethamine alone in uncomplicated falciparum<unk> . There is insufficient data on chlorproguanil-dapsone in treating uncomplicated falciparum<unk> . The addition of primaquine with artemisinin-based combination therapy for falciparum<unk>  reduces its transmission at day 3-4 and day 8 of infection. Sulfadoxine-pyrimethamine plus artesunate is better than sulfadoxine-pyrimethamine plus amodiaquine in controlling treatment failure at day 28. However, the latter is better than the former in reducing gametocytes in blood at day 7. Infection with P. vivax, P. ovale or P.<unk> e usually does not require hospitalisation. Treatment of P. vivax requires both treatment of blood stages (with chloroquine or ACT) and clearance of liver forms with primaquine. Artemisinin-based combination therapy is as effective as chloroquine in treating uncomplicated P. vivax<unk> . Treatment with tafenoquine prevents relapses after confirmed P. vivax<unk> . However, for those treated with chloroquine for blood stage infection, 14 days of primaquine treatment is required to prevent relapse. Shorter primaquine regimens may lead to higher relapse rates. There is no difference in effectiveness between primaquine given for seven or 14 days for prevention of relapse in vivax<unk> . The shorter regimen may be useful for those with treatment compliance problems. To treat<unk>  during pregnancy, the WHO recommends the use of quinine plus clindamycin early in the pregnancy (1st trimester), and ACT in later stages (2nd and 3rd trimesters). There is limited safety data on the antimalarial drugs in pregnancy. Severe and complicated<unk>  Cases of severe and complicated<unk>  are almost always caused by infection with P. falciparum. The other species usually cause only febrile disease. Severe and complicated<unk>  cases are medical emergencies since mortality rates are high (10% to 50%). Recommended treatment for severe<unk>  is the intravenous use of antimalarial drugs. For severe<unk> , parenteral artesunate was superior to quinine in both children and adults. In another systematic review, artemisinin derivatives (artemether and arteether) were as efficacious as quinine in the treatment of cerebral<unk>  in children. Treatment of severe<unk>  involves supportive measures that are best done in a critical care unit. This includes the management of high fevers and the seizures that may result from it. It also includes monitoring for poor breathing effort, low blood sugar, and low blood potassium. Artemisinin derivatives have the same or better efficacy than quinolones in preventing deaths in severe or complicated<unk> . Quinine loading dose helps to shorten the duration of fever and increases parasite clearance from the body. There is no difference in effectiveness when using intrarectal quinine compared to intravenous or intramuscular quinine in treating uncomplicated/complicated falciparum<unk> . There is insufficient evidence for intramuscular arteether to treat severe<unk> . The provision of rectal artesunate before transfer to hospital may reduce the rate of death for children with severe<unk> . Cerebral<unk>  is the form of severe and complicated<unk>  with the worst neurological symptoms. There is insufficient data on whether osmotic agents such as mannitol or urea are effective in treating cerebral<unk> . Routine phenobarbitone in cerebral<unk>  is associated with fewer convulsions but possibly more deaths. There is no evidence that steroids would bring treatment benefits for cerebral<unk> . There is insufficient evidence to show that blood transfusion is useful in either reducing deaths for children with severe anaemia or in improving their haematocrit in one month. There is insufficient evidence that iron chelating agents such as deferoxamine and deferiprone improve outcomes of those with<unk>  falciparum infection. Resistance Drug resistance poses a growing problem in 21st-century<unk>  treatment. In the 2000s (decade),<unk>  with partial resistance to artemisins emerged in Southeast Asia. Resistance is now common against all classes of antimalarial drugs apart from artemisinins. Treatment of resistant strains became increasingly dependent on this class of drugs. The cost of artemisinins limits their use in the developing world.<unk>  strains found on the Cambodia–Thailand border are resistant to combination therapies that include artemisinins, and may, therefore, be untreatable. Exposure of the parasite population to artemisinin monotherapies in subtherapeutic doses for over 30 years and the availability of substandard artemisinins likely drove the selection of the resistant phenotype. Resistance to artemisinin has been detected in Cambodia, Myanmar, Thailand, and Vietnam, and there has been emerging resistance in Laos. Resistance to the combination of artemisinin and piperaquine was first detected in 2013 in Cambodia, and by 2019 had spread across Cambodia and into Laos, Thailand and Vietnam (with up to 80 percent of<unk>  parasites resistant in some regions). There is insufficient evidence in unit packaged antimalarial drugs in preventing treatment failures of<unk>  infection. However, if supported by training of healthcare providers and patient information, there is improvement in compliance of those receiving treatment.
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