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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
close this folder6. Antimalarial treatment policy
View the document6.1 Assessment of in vivo therapeutic efficacy
View the document6.2 Criteria for antimalarial treatment policy change
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
open this folder and view contents11. Complex emergencies and epidemics
open this folder and view contentsAnnexes
 

6.2 Criteria for antimalarial treatment policy change

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

 

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