Objective: To evaluate the clinical presentation and outcome of Falciparum malaria in 100 hospitalized patients. Methodology: This hospital based descriptive study was conducted at Department of Medicine, Khyber Teaching Hospital, Peshawar from January 2011 to November 2011. One hundred patients of either gender, aged more than 12 years, diagnosed to have falciparum malaria on the basis of peripheral blood smear findings were included. Detailed information was recorded regarding presenting symptoms and signs of patients, response of patients to drugs used for Falciparum malaria, and complications of malaria. Results: Main presenting symptoms were fever (100%), headache (85%), chills (76%), nausea/vomiting (73%), altered level of consciousness (28%), fits (7%) and oliguria (5%). The main signs of Falciparum malaria were splenomegaly (75%), hepatomegaly (67%), anemia (60%), herpes labialis (42%) and jaundice (20%). Female patients were 42%, of whom 17% were pregnant. Ninety eight (98%) patients were treated with quinine + doxycycline, out of which seven (7%) patients died. Two (2%) patients were treated with combination of artemether and lumafantrine, both recovered completely. The common complications were anemia (60%), cerebral malaria (28%), hepatitis (20%), pulmonary edema (10%), hypoglycemia (8%), thrombocytopenia (7%), fundal hemorrhages (6%), renal failure (6%) and disseminated intravascular coagulation (5%). Conclusion: Falciparum malaria can present in a diverse spectrum. Fever with chills, headache, vomiting and altered level of consciousness are the common presenting symptoms. Anemia, cerebral malaria, hepatitis and pulmonary edema are the common complications of falciparum malaria. Response to quinine with doxycycline is good and mortality rate is 7%. Key Words: Falciparum Malaria, Quinine, Artemether, Artemisin-Based Combination Therapy, Complications.