Malaria treatment (Current WHO recommendations

1
Malaria treatment (Current WHO recommendations
guidelines)
Presentation by Dr Maryse DuguéRBM Partnership
Secretariat, Malaria Medicines Supplies
Services Copenhagen 31 January 2006
7.3
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Malaria distribution and reported case of
resistance or treatment failure
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First demonstration project in Thailand
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Adoption of ACT as first-line treatment in 2000
Countries with falciparum malaria
Few countries deployed ACTs in selected
provinces/districts
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ACT as first-line malaria treatment in 2006
Countries with falciparum malaria
Countries which adopted ACT as 1st-line
treatment
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56 countries have adopted ACTs
Updated 15 Jan. 2006
Continent Countries Drug Line
AFRICA Burundi, Cameroon, Côte d'Ivoire, DRC, Eq.Guinea, Gabon, Ghana, Guinea, Liberia, Madagascar, Senegal, STP, Sierra Leone, Sudan (S), Zanzibar AS AQ 1st
AFRICA Angola, Benin, Burkina Faso, Comoros, Ethiopia, Gambia, Guinea Bissau, Kenya Mali, Namibia, Niger, Nigeria, Rwanda, Uganda, S. Africa, Tanzania, Togo, Zambia AL 1st
AFRICA Côte d'Ivoire, Gabon, Mozambique, Sudan (N), STP, Zanzibar AL 2nd
AFRICA Mozambique, Sudan (N), South Africa (Mpumalanga) AS SP 1st
ASIA Cambodia, Thailand AS MQ 1st
ASIA Bangladesh, Bhutan, Laos, Myanmar AL 1st
ASIA Indonesia AS AQ 1st
ASIA Afghanistan, India (5 Provinces), Iran, Tajikistan, Yemen AS SP 1st
ASIA Viet Nam DP 1st
ASIA Papua New Guinea AS SP 2nd
ASIA Philippines, Iran AL 2nd
SOUTH AMERICA Ecuador, Peru AS SP 1st
SOUTH AMERICA Bolivia, Peru, Venezuela AS MQ 1st
SOUTH AMERICA Brazil, Guyana, Suriname AL 1st
AQamodiaquine ALartemether/lumefantrine
ASartesunate DPdihydroartemisinin/piperaquine
MQmefloquine SPsulfadoxine/pyrimethamine
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26 countries are deploying ACTs
Updated 15 Jan. 2006
Continent Countries Drug Line
AFRICA Burundi, Cameroon, Côte d'Ivoire, DRC, Eq.Guinea, Gabon, Ghana, Guinea, Liberia, Madagascar, Senegal, STP, Sierra Leone, Sudan (S), Zanzibar AS AQ 1st
AFRICA Angola, Benin, Burkina Faso, Comoros, Ethiopia, Gambia, Guinea Bissau, Kenya Mali, Namibia, Niger, Nigeria, Rwanda, Uganda, S. Africa, Tanzania, Togo, Zambia AL 1st
AFRICA Côte d'Ivoire, Gabon, Mozambique, Sudan (N), STP, Zanzibar AL 2nd
AFRICA Mozambique, Sudan (N), South Africa (Mpumalanga) AS SP 1st
ASIA Cambodia, Thailand AS MQ 1st
ASIA Bangladesh, Bhutan, Laos, Myanmar AL 1st
ASIA Indonesia AS AQ 1st
ASIA Afghanistan, India (5 Provinces), Iran, Tajikistan, Yemen AS SP 1st
ASIA Viet Nam DP 1st
ASIA Papua New Guinea AS SP 2nd
ASIA Philippines, Iran AL 2nd
SOUTH AMERICA Ecuador, Peru AS SP 1st
SOUTH AMERICA Bolivia, Peru, Venezuela AS MQ 1st
SOUTH AMERICA Brazil, Guyana, Suriname AL 1st
29 deploying
60 deploying
71 deploying
AQamodiaquine ALartemether/lumefantrine
ASartesunate DPdihydroartemisinin/piperaquine
MQmefloquine SPsulfadoxine/pyrimethamine
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Malaria diagnosis

• Parasitological confirmation (microscopy or
  RDT) before treatment
• Exceptions
• children under 5 years of age, from areas of high
  transmission where treatment is based on clinical
  diagnosis
• suspected severe malaria where parasitological
  confirmation is not immediately possible

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Changing antimalarial treatment policy

• Treatment failure of gt10 (as assessed through
  monitoring of therapeutic efficacy at 28 days)
• New treatment an average cure rate of gt 95 as
  assessed in clinical trials

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Treatment of uncomplicated falciparum malaria

• Artemisinin-based combination therapies (ACT)
  are the treatments recommended for all cases of
  uncomplicated falciparum malaria including
• in infants,
• in people living with HIV/AIDS
• for home-based management of malaria
• pregnant women in the 2nd and 3rd trimesters
• Exception
• 1st trimester of pregnancy

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Treatment of uncomplicated falciparum malaria

• The following ACTs are presently recommended
• artemether-lumefantrine
• artesunate amodiaquine
• artesunate mefloquine
• artesunate sulfadoxine-pyrimethamine
• Efficacy of ACTs depend on the efficacy of the
  partner medicine
• The artemisinin derivatives (oral formulations)
  and partner medicines of ACTs are not
  recommended as monotherapy

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Treatment of uncomplicated falciparum malaria

• Second-line treatment
• alternative ACT
• quinine tetracycline or doxycycline or
  clindamycin

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Treatment of severe falciparum malaria

• Any of the following antimalarial medicines are
  recommended
• Artesunate i.v. or i.m
• artemether i.m.
• quinine (i.v. infusion or i.m. injection).
• Full course of ACT or quinine clindamycin or
  doxycycline when patient can tolerate oral
  treatment

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How to contact us
Malaria Medicines Supply Services (MMSS) Roll
Back Malaria Partnership Secretariat Website
http//rbm.who.int/mmss/

• Dr Maryse Dugue
• Manager
• Tel [phone]
• E-mail duguem_at_who.int