A malaria treatment approach recommended in Switzerland by the National Reference Centre for Malaria at Swiss TPH and its partners has now informed new treatment guidance in the United States, illustrating how clinical expertise, evidence and exchange across borders can contribute to public health policy.
Rethinking malaria treatment for travellers
Reports of treatment failures with artemether–lumefantrine – a widely used treatment for Plasmodium falciparum malaria – raised an important question amongst European malaria specialists several years ago: was the standard three-day regimen sufficient for non-immune travellers?
Andreas Neumayr, a specialist in tropical and travel medicine at Swiss TPH, and colleagues examined the available evidence. Studies among non-immune European travellers had reported late treatment failures, with malaria recurring weeks after apparently successful treatment. The researchers highlighted that non-immune travellers may be at greater risk of treatment failure than people living in malaria-endemic regions. They also noted that relatively little evidence from non-immune travellers had been available when the standard regimen was established.
Importantly, the observed failures did not appear to be explained by drug resistance. Instead, pharmacokinetic evidence pointed towards insufficient exposure to lumefantrine – the longer-acting component of the treatment. In their paper published in 2017 [1], Neumayr and colleagues therefore proposed reconsidering the standard dosing strategy and extending treatment over five days.
Since 2017, the Swiss Malaria Treatment Recommendations have included an extended five-day artemether-lumefantrine regimen. The recommendations, a practical guidance for physicians treating malaria in Switzerland, are regularly updated [2] and published by the Swiss Society for Tropical and Travel Medicine (SSTTM) and the National Reference Centre for Malaria at Swiss TPH.
From shared concerns to stronger evidence
More recently, reports of artemether–lumefantrine treatment failures among international travellers also raised concerns at the US Centers for Disease Control and Prevention (CDC) about whether the standard three-day regimen remained adequate. This prompted the CDC to review US malaria surveillance and clinical consultation data, as well as published evidence on treatment failures and extended treatment regimens.
As part of this work, CDC experts contacted Neumayr to learn from the Swiss experience. A series of exchanges followed, focusing on why Switzerland had adopted the five-day regimen and how it had been implemented in practice.
“The exchange with our colleagues at the CDC shows how clinical knowledge from one country can contribute to evidence and policy elsewhere,” said Neumayr, who is explicitly acknowledged in the CDC publication [3] for his technical input and leadership in developing the Swiss treatment policy.
The CDC analysis identified 40 reported treatment failures following artemether–lumefantrine-based treatment between November 2022 and October 2025. In 85% of cases, malaria returned one to eight weeks after initial treatment. The CDC’s wider review also found that extended regimens – particularly a five-day course – were well tolerated and consistently achieved higher lumefantrine exposure.
The US findings strengthened the evidence supporting an extended treatment regimen – an approach that Switzerland had already incorporated into its clinical guidance.
From knowledge exchange to policy
In August 2026, the CDC updated its guidance to recommend a five-day artemether–lumefantrine regimen for uncomplicated P. falciparum malaria in the United States [4].
The development illustrates how Swiss TPH’s role as Switzerland’s National Reference Centre for Malaria can have an impact beyond national borders. By translating specialist clinical expertise into practical guidance and sharing evidence across countries, international collaboration can strengthen treatment recommendations and contribute to better-informed patient care.