Guidelines for the Treatment of Malaria: 3. Treatment objectives: 3.2 Severe malaria


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Guidelines for the Treatment of Malaria (WHO; 2006; 266 pages)
	Glossary
	Abbreviations
	1. Introduction
		1.1 Background
		1.2 Objectives and target audience
		1.3 Methods used in developing the guidelines and recommendations
	2. The clinical disease
	3. Treatment objectives
		3.1 Uncomplicated malaria
		3.2 Severe malaria
	4. Diagnosis of malaria
		4.1 Clinical diagnosis
		4.2 Parasitological diagnosis
		4.3 Where malaria transmission is low to moderate and/or unstable
		4.4 In stable high-transmission settings
		4.5 Malaria parasite species identification
		4.6 In epidemics and complex emergencies
	5. Resistance to antimalarial medicines⁹
		5.1 Impact of resistance
		5.2 Global distribution of resistance
		5.3 Assessing resistance
	6. Antimalarial treatment policy
		6.1 Assessment of in vivo therapeutic efficacy
		6.2 Criteria for antimalarial treatment policy change
	7. Treatment of uncomplicated P. Falciparum malaria¹⁰
		7.1 Assessment
		7.2 Antimalarial combination therapy
		7.3 The choice of artemisinin-based combination therapy options
		7.4 Practical aspects of treatment with recommended ACTs
		7.5 Incorrect approaches to treatment
		7.6 Additional aspects of clinical management
		7.7 Operational issues in treatment management
		7.8 Management of treatment failures
		7.9 Treatment in specific populations and situations
		7.10 Coexisting morbidities
	8. Treatment of severe falciparum malaria¹⁴
		8.1 Definition
		8.2 Treatment objectives
		8.3 Clinical assessment
		8.4 Specific antimalarial treatment
		8.5 Practical aspects of treatment
		8.6 Follow-on treatment
		8.7 Pre-referral treatment options¹⁶
		8.8 Adjunctive treatment
		8.9 Continuing supportive care
		8.10 Additional aspects of clinical management
		8.11 Treatment during pregnancy
		8.12 Management in epidemic situations
		8.13 Hyperparasitaemia¹⁸
	9. Treatment of malaria caused by P. vivax, P. ovale or P. malariae¹⁹
		9.1 Diagnosis
		9.2 Susceptibility of P. vivax, P. ovale and P. malariae to antimalarials
		9.3 Treatment of uncomplicated vivax malaria
		9.4 Treatment of severe vivax malaria
		9.5 Treatment of malaria caused by P. ovale and P. malariae
		9.6 Monitoring therapeutic efficacy for vivax malaria
	10. Mixed malaria infections
	11. Complex emergencies and epidemics
		11.1 Diagnosis
		11.2 Use of rapid diagnostic tests in epidemic situations
		11.3 Management of uncomplicated malaria in epidemics
		11.4 Areas prone to mixed falciparum/vivax malaria epidemics
		11.5 Use of gametocytocidal drugs to reduce transmission
		11.6 Anti-relapse therapy in vivax malaria epidemics
		11.7 Mass treatment
	Annexes
		Annex 1. The guidelines development process
		Annex 2. Adaptation of WHO malaria treatment guidelines for use in countries
		Annex 3. Pharmacology of antimalarial drugs
		Annex 4. Antimalarials and malaria transmission
		Annex 5. Malaria diagnosis
		Annex 6. Resistance to antimalarials
		Annex 7. Uncomplicated P. falciparum malaria
		Annex 8. Malaria treatment and HIV/AIDS
		Annex 9. Treatment of severe P. falciparum malaria
		Annex 10. Treatment of P. vivax, P. ovale and P. malariae infections

3.2 Severe malaria

The primary objective of antimalarial treatment in severe malaria is to prevent death. Prevention of recrudescence and avoidance of minor adverse effects are secondary. In treating cerebral malaria, prevention of neurological deficit is also an important objective. In the treatment of severe malaria in pregnancy, saving the life of the mother is the primary objective.

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