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cerrar este libroGuidelines for the Treatment of Malaria (WHO; 2006; 266 pages) Ver el documento en el formato PDF
Ver el documentoGlossary
Ver el documentoAbbreviations
cerrar esta carpeta1. Introduction
Ver el documento1.1 Background
Ver el documento1.2 Objectives and target audience
Ver el documento1.3 Methods used in developing the guidelines and recommendations
Ver el documento2. The clinical disease
abrir esta carpeta y ver su contenido3. Treatment objectives
abrir esta carpeta y ver su contenido4. Diagnosis of malaria
abrir esta carpeta y ver su contenido5. Resistance to antimalarial medicines9
abrir esta carpeta y ver su contenido6. Antimalarial treatment policy
abrir esta carpeta y ver su contenido7. Treatment of uncomplicated P. Falciparum malaria10
abrir esta carpeta y ver su contenido8. Treatment of severe falciparum malaria14
abrir esta carpeta y ver su contenido9. Treatment of malaria caused by P. vivax, P. ovale or P. malariae19
Ver el documento10. Mixed malaria infections
abrir esta carpeta y ver su contenido11. Complex emergencies and epidemics
abrir esta carpeta y ver su contenidoAnnexes
 

1.3 Methods used in developing the guidelines and recommendations

These guidelines have been developed in accordance with the WHO Guidelines for Guidelines Development.1 In order to ensure that the guidelines are based on the best current evidence, WHO commissioned two academic centres to identify, compile and critically review published and unpublished studies of antimalarial treatments. The collated evidence was then reviewed by the Technical Guidelines Development Group made up of a broad spectrum of experts on malaria, malaria control programmes, and treatment guidelines methodology. A large number of external reviewers with a wide range of expertise were also involved in developing the guidelines.

1 The process is described in detail in Annex 1.


1.3.1 Evidence considered

In assessing the available information on treatment options, four main types of information were considered, and should also be considered by countries seeking to adapt the guidelines.2 Wherever possible, systematic reviews of randomized trials that directly compare two or more treatment alternatives in large populations were identified and used as the basis for recommendations. It is clear that such evidence does not exist for all options, but recommendations on these options still need to be made. Other information including studies measuring cure rates but not directly comparing treatments, pharmacological assessments and surveillance data about resistance patterns have therefore also been considered.

2 A guide to assist country adaptation of these guidelines is provided in Annex 2.


In relation to malaria, as with other diseases, systematic reviews are not the sole basis for decision-making: the large differences in transmission intensity, and thus baseline immunity, in treatment populations and in resistance patterns all have major effects on treatment responses. Any statistical analysis that combines the results of individual studies has to take due account of these factors and be interpreted accordingly. However, such analyses do not obviate the need for a systematic and comprehensive review of all available trials before reaching decisions about treatment recommendations.

Treatments for malaria, like those for many infectious diseases, must be considered from the perspective of community or public health benefits and harms as well as from that of the patient. In some instances, therefore, the recommendations provided here are based on public health considerations as well as the potential individual benefits.

Cost-effectiveness studies have not been included in the information considered by the Technical Guidelines Development Group at this stage for two reasons: there are very few completed, generalizable cost-effectiveness studies that relate to the main treatment options being considered and the price of the antimalarials concerned is extremely fluid, rendering such studies unreliable. However, as relevant information becomes available, it will be considered for inclusion in future editions of the guidelines.

1.3.2 Presentation of evidence

For clarity, these guidelines have adopted a simple descriptive approach; this may be revised in future editions. They are presented as a central unreferenced main document containing the recommendations. Summaries of the recommendations are given in boxes. Symbols for the evidence used as the basis of each recommendation (in order of level of evidence) are:

S

formal systematic reviews, such as a Cochrane Review, including more than one randomized controlled trial;

T

comparative trials without formal systematic review;

O

observational studies (e.g. surveillance or pharmacological data);

E

expert opinion/consensus.

In addition, for each policy or treatment question leading to a recommendation, a brief summary of evidence is provided in a separate evidence box. Full reviews of the evidence and references are provided in annexes. If pharmaco-kinetics studies have been included as part of the deliberations, this is noted in the main document.3

3 Details of the pharmacology of antimalarials are provided in Annex 3.

 

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