Why does WHO recommend ACTs instead of a single drug?

Because the fast-acting artemisinin clears most parasites within days while the longer-acting partner drug eliminates the rest. Using two drugs together makes it much harder for parasites to develop resistance.

How many days is an ACT course?

WHO states that every ACT regimen must provide 3 days of treatment with an artemisinin derivative — shorter courses are not recommended.

What Is ACT (Artemisinin Combination Therapy)? WHO Guide

The short answer

ACT stands for artemisinin-based combination therapy. It is a malaria treatment that pairs a fast-killing artemisinin derivative (such as artemether or artesunate) with a longer-lasting partner drug. Since 2015, the World Health Organization (WHO) has recommended ACTs — with a strong recommendation and high-certainty evidence — as the first-line treatment for uncomplicated Plasmodium falciparum malaria, the deadliest malaria species.

Why combine two drugs?

Speed: the artemisinin component reduces the parasite load by roughly 90% within 24–48 hours, bringing fever down fast.
Complete cure: the partner drug stays in the blood longer and kills the parasites the artemisinin missed.
Resistance protection: two drugs with different mechanisms make it far harder for resistant parasites to survive and spread.

The 6 ACTs WHO recommends

Artemether–lumefantrine (AL) — the most widely used ACT worldwide
Artesunate–amodiaquine (AS+AQ)
Artesunate–mefloquine (ASMQ)
Dihydroartemisinin–piperaquine (DHAP)
Artesunate + sulfadoxine-pyrimethamine (AS+SP)
Artesunate–pyronaridine (ASPY) — added in 2022; avoid in known liver disease

Two rules every buyer should know

The 3-day rule: WHO requires every ACT course to contain 3 days of the artemisinin component. Beware of substandard 1- or 2-day packs on some markets.
Test first: ACTs should only be given after a confirmed diagnosis (microscopy or rapid diagnostic test) — see our guide on malaria testing.

What this means for procurement

National malaria programs and tenders almost always specify one or more of these six ACTs. When sourcing, confirm the exact strength per weight band, the 3-day course packaging, and that the manufacturer can supply batch COA and CTD documentation for registration.

Source: summarised in plain language from the WHO Guidelines for Malaria (10 September 2026), World Health Organization. This guide is for buyer education only — clinical decisions must follow the locally approved product insert and national treatment guidelines.