These malaria treatment guidelines recommend that antimalarial treatment policy should be changed at treatment failure rates considerably lower than those recommended previously. This major change reflects the availability of highly effective drugs, and the recognition both of the consequences of drug resistance, in terms of morbidity and mortality, and the importance of high cure rates in malaria control.
It is now recommended that a change of first-line treatment should be initiated if the total failure proportion exceeds 10%. However, it is acknowledged that a decision to change may be influenced by a number of additional factors, including the prevalence and geographical distribution of reported treatment failures, health service provider and/or patient dissatisfaction with the treatment, the political and economical context, and the availability of affordable alternatives to the commonly used treatment.
Summary of recommendations on changing antimalarial treatment policy
RECOMMENDATIONS |
LEVEL OF EVIDENCE |
In therapeutic efficacy assessments, the cure rate should be defined parasitologically, based on a minimum of 28 days of follow-up. Molecular genotyping using PCR technology should be used to distinguish recrudescent parasites from newly acquired infections. |
E |
Review and change of the antimalarial treatment policy should be initiated when the cure rate with the current recommended medicine falls below 90% (as assessed through monitoring of therapeutic efficacy). |
E |
A new recommended antimalarial medicine adopted as policy should have an average cure rate ≥95% as assessed in clinical trials. |
E |
