Risks and Benefits of Targeted Malaria Treatment Based on Rapid Diagnostic Test Results

In this issue of Clinical Infectious Diseases, d’Acremont et al [1] importantly address the clinical safety of withholding antimalarial treatment in febrile children who have a negative result for one of the newly developed rapid diagnostic tests (RDTs) for malaria. Restricting malaria treatment to patients with parasitologically confirmed malaria infection has become increasingly important in the era of artemisininbased combination therapy (ACT). This importance is reflected in the World Health Organization’s new recommendation: “Prompt parasitological confirmation by microscopy or alternatively by RDTs is recommended in all patients suspected of malaria before treatment is started. Treatment solely on the basis of clinical suspicion should only be considered when a parasitological diagnosis is not accessible” [2, p 13]. The rationale for this is that unnecessary antimalarial treatment will put non–malaria-infected patients at risk of adverse drug events and,