Malaria treatment (Current WHO

recommendations & guidelines)

Presentation by Dr Maryse Dugu
RBM Partnership Secretariat, Malaria Medicines & Supplies Services

Copenhagen 31 January 2006
7.3
Malaria distribution and reported
case of resistance or treatment failure
40
60
80
100
1
9
8
5

-

8
6
1
9
9
0
1
9
9
1
1
9
9
2
1
9
9
3
1
9
9
4
1
9
9
5
1
9
9
6
1
9
9
7
1
9
9
8
1
9
9
9
Year
Cured (%)
Mefloquine
15
Mefloquine
25
Mefloquine +
artesunate
Treatment efficacy at Thai-Burmese border
First demonstration project
in Thailand
Countries with falciparum malaria
Few countries deployed ACTs
in selected provinces/districts
Adoption of ACT as first-line
treatment in 2000
Countries with falciparum malaria
Countries which adopted ACT
as 1
st
-line treatment
ACT as first-line malaria treatment
in 2006
Continent Countries Drug Line


AFRICA
Burundi, Cameroon, Cte d'Ivoire, DRC, Eq.Guinea, Gabon, Ghana, Guinea,
Liberia, Madagascar, Senegal, ST&P, Sierra Leone, Sudan (S), Zanzibar
AS + AQ 1
st
Angola, Benin, Burkina Faso, Comoros, Ethiopia, Gambia, Guinea Bissau, Kenya
Mali, Namibia, Niger, Nigeria, Rwanda, Uganda, S. Africa, Tanzania, Togo, Zambia
AL 1
st
Cte d'Ivoire, Gabon, Mozambique, Sudan (N), ST&P, Zanzibar AL 2
nd
Mozambique, Sudan (N), South Africa (Mpumalanga) AS + SP 1
st



ASIA


Cambodia, Thailand AS + MQ 1
st
Bangladesh, Bhutan, Laos, Myanmar AL 1
st
Indonesia AS + AQ 1
st
Afghanistan, India (5 Provinces), Iran, Tajikistan, Yemen AS + SP 1
st
Viet Nam DP 1
st
Papua New Guinea AS + SP 2
nd
Philippines, Iran AL 2
nd
SOUTH
AMERICA
Ecuador, Peru AS + SP 1
st
Bolivia, Peru, Venezuela AS + MQ 1
st
Brazil, Guyana, Suriname AL 1
st
Updated
15 J an.
2006
AQ=amodiaquine; AL=artemether/lumefantrine; AS=artesunate; DP=dihydroartemisinin/piperaquine; MQ=mefloquine;
SP=sulfadoxine/pyrimethamine
56 countries have adopted ACTs
Continent Countries Drug Line


AFRICA
Burundi, Cameroon, Cte d'Ivoire, DRC, Eq.Guinea, Gabon, Ghana, Guinea, Liberia,
Madagascar, Senegal, ST&P, Sierra Leone, Sudan (S), Zanzibar
AS + AQ 1
st
Angola, Benin, Burkina Faso, Comoros, Ethiopia, Gambia, Guinea Bissau, Kenya
Mali, Namibia, Niger, Nigeria, Rwanda, Uganda, S. Africa, Tanzania, Togo, Zambia
AL 1
st
Cte d'Ivoire, Gabon, Mozambique, Sudan (N), ST&P, Zanzibar AL 2
nd
Mozambique, Sudan (N), South Africa (Mpumalanga) AS + SP 1
st



ASIA


Cambodia, Thailand AS + MQ 1
st
Bangladesh, Bhutan, Laos, Myanmar AL 1
st
Indonesia AS + AQ 1
st
Afghanistan, India (5 Provinces), Iran, Tajikistan, Yemen AS + SP 1
st
Viet Nam DP 1
st
Papua New Guinea AS + SP 2
nd
Philippines, Iran AL 2
nd
SOUTH
AMERICA
Ecuador, Peru AS + SP 1
st
Bolivia, Peru, Venezuela AS + MQ 1
st
Brazil, Guyana, Suriname AL 1
st
29% deploying
AQ=amodiaquine; AL=artemether/lumefantrine; AS=artesunate; DP=dihydroartemisinin/piperaquine; MQ=mefloquine; SP=sulfadoxine/pyrimethamine
60% deploying
71% deploying
Updated
15 J an.
2006
26 countries are deploying ACTs
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
Changing
antimalarial treatment policy
Treatment failure of >10% (as assessed
through monitoring of therapeutic efficacy
at 28 days)

New treatment an average cure rate
of > 95% as assessed in clinical trials
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 2
nd
and 3
rd

trimesters
Exception:
1
st
trimester of pregnancy

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
Treatment of uncomplicated
falciparum malaria
Second-line treatment:
alternative ACT
quinine + tetracycline
or doxycycline
or clindamycin
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
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: +41 (0)22 791 4439
E-mail: duguem@who.int