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close this bookGuidelines for the Treatment of Malaria (WHO; 2006; 266 pages) View the PDF document
View the documentGlossary
View the documentAbbreviations
open this folder and view contents1. Introduction
View the document2. The clinical disease
open this folder and view contents3. Treatment objectives
open this folder and view contents4. Diagnosis of malaria
open this folder and view contents5. Resistance to antimalarial medicines9
open this folder and view contents6. Antimalarial treatment policy
open this folder and view contents7. Treatment of uncomplicated P. Falciparum malaria10
close this folder8. Treatment of severe falciparum malaria14
View the document8.1 Definition
View the document8.2 Treatment objectives
View the document8.3 Clinical assessment
View the document8.4 Specific antimalarial treatment
View the document8.5 Practical aspects of treatment
View the document8.6 Follow-on treatment
View the document8.7 Pre-referral treatment options16
View the document8.8 Adjunctive treatment
View the document8.9 Continuing supportive care
View the document8.10 Additional aspects of clinical management
View the document8.11 Treatment during pregnancy
View the document8.12 Management in epidemic situations
View the document8.13 Hyperparasitaemia18
open this folder and view contents9. Treatment of malaria caused by P. vivax, P. ovale or P. malariae19
View the document10. Mixed malaria infections
open this folder and view contents11. Complex emergencies and epidemics
open this folder and view contentsAnnexes
 

8.12 Management in epidemic situations

Management of severe falciparum malaria in epidemic situations will often take place in temporary clinics or in situations in which staff shortages and high workloads make intensive care monitoring difficult. Drug treatment should therefore be as simple and safe as possible, with simple dosing schedules and a minimum need for monitoring. Artesunate has been shown to reduce mortality of severe malaria, but with the current artesunate formulation, drawing the drug into a syringe takes two dissolution-dilution steps. In some circumstances this may not be possible. Parenteral quinine requires either intravenous infusions or a three times a day intramuscular regimen, plus monitoring of blood glucose. Thus the simple once a day regimens and the ease of drawing up and administering intramuscular artemether make this a suitable alternative for severe malaria in most epidemic situations. Experience with artesunate suppositories in epidemic situations is limited. Their use may be appropriate in severely ill patients who are unable to swallow oral medication when intramuscular artemether (or quinine by intravenous infusion) is unavailable. If artesunate suppositories are used, patients should be moved as soon as possible to a facility where intramuscular or intravenous therapy can be started.

When the patient cannot be moved, continued treatment with rectal artesunate is appropriate until oral drugs can be taken. It is essential that a full course of antimalarial treatment is completed.

8.12.1 Treatment during pregnancy in epidemic situations

In epidemic settings where the need for simplicity is paramount, intramuscular artemether is the drug of choice for severe malaria in all trimesters of pregnancy.

Summary of recommendation on treatment of severe falciparum malaria in pregnant women in epidemic situations

RECOMMENDATION

LEVEL OF EVIDENCE

Artesunate by the intravenous route is the treatment of choice, but if not possible, artemether by the intramuscular route is the preferred alternative for severe malaria in pregnancy during a malaria epidemic.

E

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