Malaria treatment (Current WHO recommendations & guidelines)

1. Malaria treatment (Current WHO recommendations & guidelines) Presentation by Dr Maryse DuguéRBM Partnership Secretariat, Malaria Medicines & Supplies Services Copenhagen – 31 January 2006 7.3

2. Malaria distribution and reported case of resistance or treatment failure

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

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

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

6. 56 countries have adopted ACTs Updated 15 Jan. 2006 AQ=amodiaquine; AL=artemether/lumefantrine; AS=artesunate; DP=dihydroartemisinin/piperaquine; MQ=mefloquine; SP=sulfadoxine/pyrimethamine

7. 26 countries are deploying ACTs Updated 15 Jan. 2006 29% deploying 60% deploying 71% deploying AQ=amodiaquine; AL=artemether/lumefantrine; AS=artesunate; DP=dihydroartemisinin/piperaquine; MQ=mefloquine; SP=sulfadoxine/pyrimethamine

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 2nd and 3rd trimesters Exception: • 1st 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… Dr Maryse Dugue Manager Tel: +41 (0)22 791 4439 E-mail: duguem@who.int Malaria Medicines & Supply Services (MMSS) Roll Back Malaria Partnership Secretariat Website: http://rbm.who.int/mmss/