Management of uncomplicated Plasmodium falciparum malaria with artemisinin-based combination therapy: Factors associated with hospitalization and clinical, biological, and parasitological outcomes.

BACKGROUND

Uncomplicated Plasmodium falciparum malaria is a common imported infection in non-endemic countries. We evaluated management, early follow-up, and factors associated with hospitalization at initial presentation among patients treated with artemisinin-based combination therapies (ACTs) in France.

METHODS

We conducted a national retrospective study including adults diagnosed with uncomplicated Plasmodium falciparum malaria without vomiting, treated with ACTs, and reported to the French National Reference Center for Malaria between 2021 and 2024. The primary endpoint was factors associated with hospitalization at initial presentation (versus outpatient management), assessed using multivariable and mixed-effects logistic regression. Early clinical, biological, and parasitological follow-up (days 1-7) was analyzed descriptively.

RESULTS

Among 3,248 patients treated with ACTs, 1,210/3,087 (39.2%) were hospitalized at the time of initial presentation. Fever, immunosuppression, platelet count <84 G/L, parasitemia ≥0.16%, and hemoglobin <12.4 g/dL were independently associated with hospitalization, whereas diagnosis in 2024 was associated with a lower risk. Among the 1,098 (33.8%) patients with available follow-up data, adverse events occurred in <2%. Among patients whose first documented parasitological assessment occurred during days 1-3, the parasite positivity rate was 11/460 (2.4%); no positive parasitemia was observed among those whose first documented assessment occurred during days 4-7 (0/215). In the mixed-effects model, age ≥50 years was also associated with hospitalization.

CONCLUSION

In this large national cohort, an evolving trend toward more frequent outpatient management in real-world practice was observed. The lack of documented early follow-up data in both inpatients and outpatients highlights the need to improve follow-up monitoring and reporting.