India is endemic for malaria with unstable transmission inhibiting the development of immunity and predisposing all age groups to the disease. Children under five are the greatest sufferers with maximum mortality. P. falciparum and P. vivax cause majority of cases. Fever is the cardinal symptom, though no set of signs and symptoms reliably distinguishes malaria from other causes of fever. In all suspected cases parasitological diagnosis should be confirmed before starting the treatment. Microscopy of blood smears is the gold standard for diagnosis. Rapid diagnostic tests are to be used where microscopy results are not available within 24 h. In complicated malaria and high risk patients like HIV, treatment can be commenced before confirmation, though all efforts to establish the diagnosis should be made. Chloroquine is used for uncomplicated vivax malaria while artemisinin based combination therapy (ACTs) is used for uncomplicated falciparum malaria. For complicated malaria, IV artesunate is the drug of choice irrespective of the Plasmodium species. It is important to follow recommendations diligently to decrease morbidity and mortality due to malaria and to avoid the problem of drug resistance. The gains of the past decade should be scaled up to make malaria elimination and eradication a reality.
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