French Guiana, the last malaria-endemic region of France, is facing an epidemic resurgence of malaria since the end of 2023. This epidemic, primarily caused by , mainly affects populations that are far from the healthcare system. It has highlighted the difficulties of providing a full course of treatment. This includes both curative treatment with artemisinin derivatives (following the withdrawal of chloroquine from the market) and eradicative treatment with primaquine, with the challenge of excluding G6PD deficiency. The aim of this paper is to describe the problems of malaria diagnosis and management in this unique territory, to highlight the adaptations made and to propose diagnostic, therapeutic and follow-up schemes adapted to the possibilities of access to the health system, with a view to homogenizing practices. This article also highlights the innovative strategies implemented in French Guiana to deal with this new epidemic: health mediation, mobile malaria team, rapid diagnostic tests and immediate out-of-hospital treatment Test and Treat, development of self-diagnosis and self-treatment. These proposals are part of a campaign to eliminate malaria in France in the short term.