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fermer ce livreGuidelines for the Treatment of Malaria (WHO; 2006; 266 pages) Voir le document au format PDF
Afficher le documentGlossary
Afficher le documentAbbreviations
ouvrir ce répertoire et afficher son contenu1. Introduction
Afficher le document2. The clinical disease
ouvrir ce répertoire et afficher son contenu3. Treatment objectives
ouvrir ce répertoire et afficher son contenu4. Diagnosis of malaria
ouvrir ce répertoire et afficher son contenu5. Resistance to antimalarial medicines9
fermer ce répertoire6. Antimalarial treatment policy
Afficher le document6.1 Assessment of in vivo therapeutic efficacy
Afficher le document6.2 Criteria for antimalarial treatment policy change
ouvrir ce répertoire et afficher son contenu7. Treatment of uncomplicated P. Falciparum malaria10
ouvrir ce répertoire et afficher son contenu8. Treatment of severe falciparum malaria14
ouvrir ce répertoire et afficher son contenu9. Treatment of malaria caused by P. vivax, P. ovale or P. malariae19
Afficher le document10. Mixed malaria infections
ouvrir ce répertoire et afficher son contenu11. Complex emergencies and epidemics
ouvrir ce répertoire et afficher son contenuAnnexes
 

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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