US CDC Extends Malaria Treatment Course to Five Days
The United States Centers for Disease Control and Prevention (CDC) has extended its recommended treatment duration for uncomplicated Plasmodium falciparum malaria from three days to five days when using artemether-lumefantrine, a widely used antimalarial drug. The updated guidance, issued in August 2026, recommends a 10-dose regimen taken twice daily for five days, replacing the previous six-dose, three-day schedule.
The change follows a review of malaria treatment failures reported among international travellers and other patients treated in the US. According to a study published on August 19, 2026, in the journal Clinical Infectious Diseases, titled “Extending the Duration of Artemether-Lumefantrine Treatment for Uncomplicated Plasmodium falciparum Malaria,” the longer course is intended to reduce the risk of treatment failure, particularly late recurrences—when parasites not completely cleared return weeks after treatment.
The review found that extended dosages were well tolerated and consistently produced higher exposure to lumefantrine, the longer-acting component of the combination therapy. Researchers estimated the pooled risk of treatment failure at about 7% in studies conducted from 2018 onwards, compared with 4% in earlier studies, though they noted the difference was not statistically significant.
Artemether-lumefantrine, also sold under the brand name Coartem, is an artemisinin-based combination therapy (ACT) used to treat uncomplicated malaria. For patients weighing 35 kg or more, the CDC recommends a dose of two tablets per administration, each containing 20mg of artemether and 120mg of lumefantrine, taken twice daily for five days. The number of tablets per dose is lower for children, based on weight.
The CDC also advises that the medicine should be taken with fatty food or a milky drink to improve absorption.
Scope of the New Guidance
The CDC’s updated recommendation is specific to US treatment guidance. It does not automatically change malaria treatment recommendations in Nigeria or elsewhere. Health officials in both reports emphasised that treatment guidelines can differ between countries based on local malaria patterns, drug effectiveness, and national policies. The key message for Nigerians is to get malaria confirmed through appropriate testing and to follow the treatment prescribed by a qualified healthcare professional, rather than changing the duration or dosage of medication based on the US announcement.
The CDC has not said that the three-day regimen no longer works. Instead, the change is aimed at reducing the risk of late failures in the US context.
The World Health Organisation (WHO) continues to list artemether-lumefantrine among its recommended ACTs for uncomplicated P. falciparum malaria. WHO has also warned that emerging artemisinin resistance threatens the effectiveness of these medicines and requires continued monitoring. Researchers behind the new review call for more data from malaria-endemic countries to monitor treatment effectiveness, underscoring the ongoing need for vigilance in the fight against malaria.