malaria treatment (current who recommendations & guidelines) presentation by dr maryse dugué...
TRANSCRIPT
Malaria treatment (Current WHO recommendations & guidelines)
Presentation by Dr Maryse DuguéRBM Partnership Secretariat, Malaria Medicines & Supplies Services
Copenhagen – 31 January 2006 7.3
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: [email protected]