13 August 2025
Malaria treatment
We have recently reviewed content in BNF and BNF for Children (BNFC) relating to the treatment of malaria following updates to clinical guidance from the UK Health Security Agency (UKHSA) and World Health Organization (WHO).
For the antimalarial, piperaquine phosphate with artenimol, the drug monograph was previously retired from BNF and BNFC in early 2024 as the UK licensed preparation, Eurartesim®, was discontinued. Subsequently, UKHSA published guidance for the management of treatment failure (recrudescence) in falciparum malaria that recommends piperaquine phosphate with artenimol as a treatment option. The UK Malaria Expert Advisory Group (UKMEAG, formerly known as the Advisory Committee on Malaria Prevention) confirmed that piperaquine phosphate with artenimol is used in clinical practice in the UK for malaria treatment, and is imported from other countries. We have therefore reintroduced the drug monograph to BNF and BNFC. Indications and dosing are similar to that previously licensed in the UK, although an indication for use in non-falciparum malaria has been included, and dosing for children under 25 kg follows WHO guidelines for malaria 2024 and UK malaria treatment guidelines 2016. Information on the use of piperaquine phosphate with artenimol during pregnancy has also been updated as there is now more available data to support use in the second and third trimesters.
A new UK licensed preparation of intravenous artesunate is available, and a new drug monograph has been introduced to BNF and BNFC. Prescribing information for artesunate mainly corresponds to licensed product literature; although similarly to piperaquine phosphate with artenimol, dosing for children under 20 kg follows WHO guidelines for malaria 2024 and UK malaria treatment guidelines 2016.
Changes to BNF and BNFC have been guided by expert input from UKMEAG to ensure relevance to UK practice. They have also been ratified by our governance committees: BNF Joint Formulary Committee and BNFC Paediatric Formulary Committee. The Piperaquine phosphate with artenimol drug monograph, as well as updates to the treatment summary for Malaria, treatment were published for the August 2025 update for online and app versions. A new drug monograph for Artesunate was published for July 2025. Additionally, the treatment summary for Malaria, prophylaxis was also recently updated (June 2025) based on UKHSA guidance for malaria prevention in travellers from the UK.
