Malaria treatment (Current WHO recommendations & guidelines)

Presentation by Dr Maryse DuguéRBM 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

Year

Cured (%)

Mefloquine15

Mefloquine25

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 1st-line treatment

ACT as first-line malaria treatment in 2006

Continent Countries Drug Line

AFRICA

Burundi, Cameroon, Côte d'Ivoire, DRC, Eq.Guinea, Gabon, Ghana, Guinea, Liberia, Madagascar, Senegal, ST&P, Sierra Leone, Sudan (S), Zanzibar

AS + AQ 1st

Angola, Benin, Burkina Faso, Comoros, Ethiopia, Gambia, Guinea Bissau, Kenya Mali, Namibia, Niger, Nigeria, Rwanda, Uganda, S. Africa, Tanzania, Togo, Zambia

AL 1st

Côte d'Ivoire, Gabon, Mozambique, Sudan (N), ST&P, Zanzibar AL 2nd

Mozambique, Sudan (N), South Africa (Mpumalanga) AS + SP 1st

ASIA

Cambodia, Thailand AS + MQ 1st

Bangladesh, Bhutan, Laos, Myanmar AL 1st

Indonesia AS + AQ 1st

Afghanistan, India (5 Provinces), Iran, Tajikistan, Yemen AS + SP 1st

Viet Nam DP 1st

Papua New Guinea AS + SP 2nd

Philippines, Iran AL 2nd

SOUTH

AMERICA

Ecuador, Peru AS + SP 1st

Bolivia, Peru, Venezuela AS + MQ 1st

Brazil, Guyana, Suriname AL 1st

Updated 15 Jan.

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, Côte d'Ivoire, DRC, Eq.Guinea, Gabon, Ghana, Guinea, Liberia, Madagascar, Senegal, ST&P, Sierra Leone, Sudan (S), Zanzibar

AS + AQ 1st

Angola, Benin, Burkina Faso, Comoros, Ethiopia, Gambia, Guinea Bissau, Kenya Mali, Namibia, Niger, Nigeria, Rwanda, Uganda, S. Africa, Tanzania, Togo, Zambia

AL 1st

Côte d'Ivoire, Gabon, Mozambique, Sudan (N), ST&P, Zanzibar AL 2nd

Mozambique, Sudan (N), South Africa (Mpumalanga) AS + SP 1st

ASIA

Cambodia, Thailand AS + MQ 1st

Bangladesh, Bhutan, Laos, Myanmar AL 1st

Indonesia AS + AQ 1st

Afghanistan, India (5 Provinces), Iran, Tajikistan, Yemen AS + SP 1st

Viet Nam DP 1st

Papua New Guinea AS + SP 2nd

Philippines, Iran AL 2nd

SOUTH

AMERICA

Ecuador, Peru AS + SP 1st

Bolivia, Peru, Venezuela AS + MQ 1st

Brazil, Guyana, Suriname AL 1st

29% deploying

AQ=amodiaquine; AL=artemether/lumefantrine; AS=artesunate; DP=dihydroartemisinin/piperaquine; MQ=mefloquine; SP=sulfadoxine/pyrimethamine

60% deploying

71% deploying

Updated 15 Jan.

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 2nd and 3rd

trimesters

Exception:• 1st 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