1. Introduction 1
1.1 Background 1
1.2 Objectives and target audience 2
1.3 Methods used in developing the guidelines and recommendations 3
2. The clinical disease 5
3. Treatment objectives 7
3.1 Uncomplicated malaria 7
3.2 Severe malaria 7
4. Diagnosis of malaria 8
4.1 Clinical diagnosis 8
4.2 Parasitological diagnosis 9
4.3 Where malaria transmission is low–moderate and/or unstable 10
4.4 In stable high-transmission settings 10
4.5 Malaria parasite species identification 11
4.6 In epidemics and complex emergencies 11
5. Resistance to antimalarial medicines 12
5.1 Impact of resistance 12
5.2 Global distribution of resistance 12
5.3 Assessing resistance 13
6. Antimalarial treatment policy 14
6.1 Assessment of in vivo therapeutic efficacy 14
6.2 Criteria for antimalarial treatment policy change 15
7. Treatment of uncomplicated P. falciparum malaria 16
7.1 Assessment 16
7.2 Antimalarial combination therapy 16
7.3 The choice of artemisinin based combination therapy options 20
7.4 Practical aspects of treatment with recommended ACTs 23
7.5 Incorrect approaches to treatment 26
7.6 Additional aspects of clinical management 27
7.7 Operational issues in treatment management 29
7.8 Management of treatment failures 31
7.9 Treatment in specific populations and situations 32
7.10 Coexisting morbidities 38
Contents

iii

Guidelines for the treatment of malaria

iv

8. Treatment of severe falciparum malaria 41
8.1 Definition 41
8.2 Treatment objectives 41
8.3 Clinical assessment 42
8.4 Specific antimalarial treatment 42
8.5 Practical aspects of treatment 47
8.6 Follow-on treatment 48
8.7 Pre-referral treatment options 49
8.8 Adjunctive treatment 51
8.9 Continuing supportive care 53
8.10 Additional aspects of clinical management 54
8.11 Treatment during pregnancy 58
8.12 Management in epidemic situations 59
8.13 Hyperparasitaemia 60
9. Treatment of malaria caused by P. vivax, P. ovale or P. malariae 62
9.1 Diagnosis 62
9.2 Susceptibility of P. vivax, P. ovale and P. malariae to antimalarials 63
9.3 Treatment of uncomplicated vivax malaria 63
9.4 Treatment of severe vivax malaria 66
9.5 Treatment of malaria caused by P. ovale and P. malariae 66
9.6 Monitoring therapeutic efficacy for vivax malaria 66
10. Mixed malaria infections 68
11. Complex emergencies and epidemics 69
11.1 Diagnosis 69
11.2 Use of rapid diagnostic tests in epidemic situations 69
11.3 Management of uncomplicated malaria in epidemics 70
11.4 Areas prone to mixed falciparum/vivax malaria epidemics 70
11.5 Use of gametocytocidal drugs to reduce transmission 71
11.6 Anti-relapse therapy in vivax malaria epidemics 71
11.7 Mass treatment 71
Annexes
Annex 1. The guidelines development process 77
Annex 2. Adaptation of WHO malaria treatment guidelines for use
in countries 83
Annex 3. Pharmacology of antimalarial drugs 87
Annex 4. Antimalarials and malaria transmission 133
Annex 5. Malaria diagnosis 147
Annex 6. Resistance to antimalarials 155
Annex 7. Uncomplicated P. falciparum malaria 185
Annex 8. Malaria treatment and HIV/AIDS 198
Annex 9. Treatment of severe P. falciparum malaria 207
Annex 10. Treatment of P. vivax, P. ovale and P. malariae infections 225
Index 240

 

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