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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
open this folder and view contents8. Treatment of severe falciparum malaria14
open this folder and view contents9. Treatment of malaria caused by P. vivax, P. ovale or P. malariae19
View the document10. Mixed malaria infections
close this folder11. Complex emergencies and epidemics
View the document11.1 Diagnosis
View the document11.2 Use of rapid diagnostic tests in epidemic situations
View the document11.3 Management of uncomplicated malaria in epidemics
View the document11.4 Areas prone to mixed falciparum/vivax malaria epidemics
View the document11.5 Use of gametocytocidal drugs to reduce transmission
View the document11.6 Anti-relapse therapy in vivax malaria epidemics
View the document11.7 Mass treatment
open this folder and view contentsAnnexes
 

11.3 Management of uncomplicated malaria in epidemics

Malaria epidemics are emergencies in which populations at risk in epidemic-prone areas are mainly non-immune or only partially immune. The principles of treatment are the same as elsewhere (see section 7); the antimalarial to be used in epidemics (and complex emergencies) must be highly efficacious (≥95% cure), safe and well tolerated so that adherence to treatment is high. Complete courses of treatment should always be given in all circumstances.

The rapid and reliable antimalarial effects of ACTs and their gametocytocidal properties, which reduce transmission, make them ideal for treatment in a malaria epidemic. An active search should be made for febrile patients to ensure that, as many cases as possible are treated, rather than relying on patients to come to a clinic.

Summary of recommendations on treatment of uncomplicated malaria in epidemic situations

RECOMMENDATIONS

LEVEL OF EVIDENCE

ACTs are recommended for antimalarial treatment in epidemics in all areas with the exception of countries in Central America and the Island of Hispaniola, where chloroquine and sulfadoxine-pyrimethamine still have a very high efficacy against falciparum malaria. Chloroquine 25 mg base/kg bw divided over 3 days, combined with primaquine 0.25 mg base/kg bw, taken with food once a day for 14 days is the treatment of choice for chloroquine-sensitive P. vivax infections. In Oceania and South-East Asia the dose of primaquine should be 0.5 mg/kg bw.

O, E

In situations where ACTs are not immediately available, the most effective alternative should be used until ACTs become available.

O, E

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