{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:50:47Z","timestamp":1793145047682,"version":"4.5.0"},"reference-count":70,"publisher":"Oxford University Press (OUP)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Artemisinin-based combination therapies (ACTs) are recommended for treatment of uncomplicated Plasmodium falciparum malaria; artemether-lumefantrine (AL) is the only ACT available in the United States. Reports of AL treatment failure among international travelers raise concerns about the continued adequacy of the standard 3-day AL regimen for travelers.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We reviewed US malaria surveillance data, clinical consultation records, and antimalarial molecular resistance surveillance data at the Centers for Disease Control and Prevention (CDC). We also conducted a literature review and meta-analysis to assess the risk of treatment failure following treatment with AL or atovaquone-proguanil (AP) in travelers treated in nonendemic settings and reviewed the efficacy and safety of AL regimens with durations longer than the standard 3-day (6-dose) course.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n From November 2022 through October 2025, CDC was consulted on 47 P. falciparum treatment failures, including 40 following AL-based and 7 following AP-based treatments. All reported travel to Africa, and 62% presented with severe malaria. Among AL failures, 85% were late recrudescences occurring 1\u20138 weeks after initial treatment. In the meta-analysis, the pooled AL treatment failure risk was higher for data collected in 2018 or later (7% [95% CI, 1%\u201332%]) compared to before 2018 (4% [95% CI, 2%\u20138%]), although the difference was not statistically significant (P = .3). Extended AL regimens, particularly a 5-day (10-dose) course, were well tolerated and consistently achieved higher lumefantrine exposure.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n These findings informed updated CDC guidance recommending an extended 5-day (10-dose) course of AL for treating uncomplicated P. falciparum malaria in the United States.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/cid\/ciag456","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:16:06Z","timestamp":1785237366000},"source":"Crossref","is-referenced-by-count":3,"title":["Extending the Duration of Artemether-Lumefantrine Treatment for Uncomplicated\n Plasmodium falciparum<\/i>\n Malaria: Updated US Centers for Disease Control and Prevention Guidance Based on Review of Surveillance, Consultations, and Published Data"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9890-2664","authenticated-orcid":false,"given":"Jimee","family":"Hwang","sequence":"first","affiliation":[{"name":"Malaria Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6291-8923","authenticated-orcid":false,"given":"Eric S","family":"Halsey","sequence":"additional","affiliation":[{"name":"Travelers\u2019 Health Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7322-4625","authenticated-orcid":false,"given":"Mateusz M","family":"Plucinski","sequence":"additional","affiliation":[{"name":"Malaria Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8711-2408","authenticated-orcid":false,"given":"Joel L N","family":"Barratt","sequence":"additional","affiliation":[{"name":"Laboratory Science and Diagnostics Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]},{"name":"Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6769-7322","authenticated-orcid":false,"given":"Julie R","family":"Gutman","sequence":"additional","affiliation":[{"name":"Malaria Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8984-0895","authenticated-orcid":false,"given":"Michelle A","family":"Chang","sequence":"additional","affiliation":[{"name":"Malaria Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2631-2216","authenticated-orcid":false,"given":"Seymour G","family":"Williams","sequence":"additional","affiliation":[{"name":"Malaria Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9468-9579","authenticated-orcid":false,"given":"Kimberly 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