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Malaria treatment (Current WHO recommendations & guidelines) Presentation by Dr Maryse Dugué RBM Partnership Secretariat, Malaria Medicines & Supplies.

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Presentation on theme: "Malaria treatment (Current WHO recommendations & guidelines) Presentation by Dr Maryse Dugué RBM Partnership Secretariat, Malaria Medicines & Supplies."— Presentation transcript:

1 Malaria treatment (Current WHO recommendations & guidelines) Presentation by Dr Maryse Dugué RBM Partnership Secretariat, Malaria Medicines & Supplies Services Copenhagen – 31 January

2 Malaria distribution and reported case of resistance or treatment failure

3 Treatment efficacy at Thai-Burmese border First demonstration project in Thailand

4 Countries with falciparum malaria Few countries deployed ACTs in selected provinces/districts Adoption of ACT as first-line treatment in 2000

5 Countries with falciparum malaria Countries which adopted ACT as 1 st -line treatment ACT as first-line malaria treatment in 2006

6 ContinentCountriesDrugLine AFRICA Burundi, Cameroon, Côte d'Ivoire, DRC, Eq.Guinea, Gabon, Ghana, Guinea, Liberia, Madagascar, Senegal, ST&P, Sierra Leone, Sudan (S), Zanzibar AS + AQ1 st Angola, Benin, Burkina Faso, Comoros, Ethiopia, Gambia, Guinea Bissau, Kenya Mali, Namibia, Niger, Nigeria, Rwanda, Uganda, S. Africa, Tanzania, Togo, Zambia AL1 st Côte d'Ivoire, Gabon, Mozambique, Sudan (N), ST&P, Zanzibar AL2 nd Mozambique, Sudan (N), South Africa (Mpumalanga) AS + SP1 st ASIA Cambodia, Thailand AS + MQ1 st Bangladesh, Bhutan, Laos, Myanmar AL1 st Indonesia AS + AQ1 st Afghanistan, India (5 Provinces), Iran, Tajikistan, Yemen AS + SP1 st Viet Nam DP1 st Papua New Guinea AS + SP2 nd Philippines, Iran AL2 nd SOUTH AMERICA Ecuador, Peru AS + SP1 st Bolivia, Peru, Venezuela AS + MQ1 st Brazil, Guyana, Suriname AL1 st Updated 15 Jan AQ=amodiaquine; AL=artemether/lumefantrine; AS=artesunate; DP=dihydroartemisinin/piperaquine; MQ=mefloquine; SP=sulfadoxine/pyrimethamine 56 countries have adopted ACTs

7 ContinentCountriesDrugLine AFRICA Burundi, Cameroon, Côte d'Ivoire, DRC, Eq.Guinea, Gabon, Ghana, Guinea, Liberia, Madagascar, Senegal, ST&P, Sierra Leone, Sudan (S), Zanzibar AS + AQ1 st Angola, Benin, Burkina Faso, Comoros, Ethiopia, Gambia, Guinea Bissau, Kenya Mali, Namibia, Niger, Nigeria, Rwanda, Uganda, S. Africa, Tanzania, Togo, Zambia AL1 st Côte d'Ivoire, Gabon, Mozambique, Sudan (N), ST&P, Zanzibar AL2 nd Mozambique, Sudan (N), South Africa (Mpumalanga) AS + SP1 st ASIA Cambodia, Thailand AS + MQ1 st Bangladesh, Bhutan, Laos, Myanmar AL1 st Indonesia AS + AQ1 st Afghanistan, India (5 Provinces), Iran, Tajikistan, Yemen AS + SP1 st Viet Nam DP1 st Papua New Guinea AS + SP2 nd Philippines, Iran AL2 nd SOUTH AMERICA Ecuador, Peru AS + SP1 st Bolivia, Peru, Venezuela AS + MQ1 st Brazil, Guyana, Suriname AL1 st 29% deploying AQ=amodiaquine; AL=artemether/lumefantrine; AS=artesunate; DP=dihydroartemisinin/piperaquine; MQ=mefloquine; SP=sulfadoxine/pyrimethamine 60% deploying 71% deploying Updated 15 Jan countries are deploying ACTs

8 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

9 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

10 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

11 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

12 Treatment of uncomplicated falciparum malaria Second-line treatment: –alternative ACT –quinine + tetracycline or doxycycline or clindamycin

13 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

14 How to contact us… Malaria Medicines & Supply Services (MMSS) Roll Back Malaria Partnership Secretariat Website: Dr Maryse Dugue Manager Tel: +41 (0)


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