Transcript (Current WHO recommendations & guidelines) Presentation by Dr Maryse Dugué M

Malaria treatment (Current WHO
recommendations & guidelines)
Presentation by Dr Maryse Dugué
RBM Partnership Secretariat, Malaria Medicines & Supplies Services
Copenhagen – 31 January 2006
7.3
Malaria distribution and reported
case of resistance or treatment failure
First demonstration project
in Thailand
Treatment efficacy at Thai-Burmese border
Cured (%)
100
Mefloquine +
artesunate
80
Mefloquine25
Mefloquine15
60
19
Year
99
19
98
19
97
19
96
19
95
19
94
19
93
19
92
19
91
19
90
19
85
-8
6
40
Adoption of ACT as first-line
treatment in 2000
Countries with falciparum malaria
Few countries deployed ACTs
in selected provinces/districts
ACT as first-line malaria treatment
in 2006
Countries with falciparum malaria
Countries which adopted ACT
as 1st-line treatment
56 countries have adopted ACTs
Continent
AFRICA
ASIA
SOUTH
AMERICA
Updated
15 Jan.
2006
Countries
Drug
Line
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
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
Ecuador, Peru
AS + SP
1st
Bolivia, Peru, Venezuela
AS + MQ
1st
Brazil, Guyana, Suriname
AL
1st
AQ=amodiaquine; AL=artemether/lumefantrine; AS=artesunate; DP=dihydroartemisinin/piperaquine; MQ=mefloquine;
SP=sulfadoxine/pyrimethamine
26 countries are deploying ACTs
Continent
AFRICA
Updated
15 Jan.
2006
Countries
Drug
Line
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
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
29% deploying
ASIA
60% deploying
SOUTH
AMERICA
Ecuador, Peru
AS + SP
1st
Bolivia, Peru, Venezuela
AS + MQ
1st
71% deploying
Brazil, Guyana, Suriname
AL
1st
AQ=amodiaquine; AL=artemether/lumefantrine; AS=artesunate; DP=dihydroartemisinin/piperaquine; MQ=mefloquine; SP=sulfadoxine/pyrimethamine
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]