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| Guidelines for the Treatment of Malaria, 3rd edition. By World Health Organization WHO 2015 |
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Overview
Malaria case management, which consists of prompt diagnosis and effective treatment, remains a vital component of malaria control and elimination strategies. This third edition of the WHO Guidelines for the treatment of malaria contains updated recommendations based on new evidence as well as a recommendation on the use of drugs to prevent malaria in high-risk groups.The core principles underpinning this edition include: early diagnosis and prompt, effective treatment; rational use of antimalarial treatment to ensure that only confirmed malaria cases receive antimalarials; the use of combination therapy in preventing or delaying development of resistance; and appropriate weight-based dosing of antimalarials to ensure prolonged useful therapeutic life and an equal chance of being cured for all patients.The Guidelines include recommendations on the diagnosis and treatment of uncomplicated and severe malaria by all species, including in special at-risk populations (such as young children, pregnant women, TB or HIV/AIDS patients and non-immune travellers) and situations (such as epidemics and humanitarian emergencies), and on the use of drugs to prevent malaria in groups at high risk. They aim:- to assist policy-makers to design and refine effective national treatment policies on the basis of the best available evidence;
- to help hospital and clinical care providers to design and refine effective treatment protocols on the basis of the best available evidence;
- to promote the use of safe, effective malaria treatment; and
- to protect currently effective malaria treatment against the development of resistance.
The recommendations in the main document are brief. For those who wish to study the evidence base in more detail, a series of annexes are provided with references to the appropriate sections of the main document.Contents
- Glossary
- Abbreviations
- EXECUTIVE SUMMARY
- 1. INTRODUCTION
- 2. CLINICAL MALARIA AND EPIDEMIOLOGY
- 3. DIAGNOSIS OF MALARIA
- 4. TREATMENT OF UNCOMPLICATED PLASMODIUM FALCIPARUM MALARIA
- 4.1 DEFINITION OF UNCOMPLICATED MALARIA
- 4.2 THERAPEUTIC OBJECTIVES
- 4.3 TREATMENT OF P. FALCIPARUM MALARIA
- 4.4 RECURRENT FALCIPARUM MALARIA
- 4.5 REDUCING THE TRANSMISSIBILITY OF TREATED P. FALCIPARUM INFECTIONS IN AREAS OF LOW-INTENSITY TRANSMISSION
- 4.6 INCORRECT APPROACHES TO TREATMENT
- 4.7 ADDITIONAL CONSIDERATIONS FOR CLINICAL MANAGEMENT
- 5. TREATMENT OF UNCOMPLICATED P. FALCIPARUM MALARIA IN SPECIAL RISK GROUPS
- 6. TREATMENT OF UNCOMPLICATED MALARIA CAUSED BY P. VIVAX, P. OVALE, P. MALARIAEOR P. KNOWLESI
- 7. TREATMENT OF SEVERE MALARIA
- 7.1 DEFINITIONS
- 7.2 THERAPEUTIC OBJECTIVES
- 7.3 CLINICAL ASSESSMENT
- 7.4 TREATMENT OF SEVERE MALARIA
- 7.5 PRE-REFERRAL TREATMENT OPTIONS
- 7.6 ADJUSTMENT OF PARENTERAL DOSING IN RENAL FAILURE OR HEPATIC DYSFUNCTION
- 7.7 FOLLOW-ON TREATMENT
- 7.8 CONTINUING SUPPORTIVE CARE
- 7.9 MANAGEMENT OF COMPLICATIONS
- 7.10 ADDITIONAL ASPECTS OF MANAGEMENT
- 7.11 TREATMENT OF SEVERE MALARIA DURING PREGNANCY
- 7.12 TREATMENT OF SEVERE P. VIVAX MALARIA
- 8. MANAGEMENT OF MALARIA CASES IN SPECIAL SITUATIONS
- 9. ARTEMISININ-BASED COMBINATION THERAPIES NOT CURRENTLY RECOMMENDED FOR GENERAL USE
- 10. MASS DRUG ADMINISTRATION
- 11. CHEMOPREVENTION IN SPECIAL RISK GROUPS
- 12. QUALITY OF ANTIMALARIAL MEDICINES
- 13. MONITORING THE EFFICACY AND SAFETY OF ANTIMALARIAL DRUGS AND RESISTANCE
- 14. NATIONAL ADAPTATION OF THE GENERIC FRAMEWORK FOR MALARIA DIAGNOSIS AND TREATMENT, AND IMPLEMENTATION
- 14.1 NATIONAL DECISION-MAKING
- 14.2 INFORMATION REQUIRED FOR NATIONAL DECISION-MAKING
- 14.3 OPPORTUNITIES AND RISKS
- 14.4 GENERAL GUIDING PRINCIPLES FOR CHOOSING A CASE MANAGEMENT STRATEGY AND TOOLS
- 14.5 CONSIDERATIONS IN USE OF ARTEMISININ-BASED COMBINATION THERAPY
- 14.6 CHOOSING AMONG FORMULATIONS
- 14.7 OTHER OPERATIONAL ISSUES IN MANAGING EFFECTIVE TREATMENT
- Annex 1 Preparation of the guidelines
- Annex 2 Malaria transmission and antimalarial medicines
- Annex 3 Malaria diagnosis
- Annex 4 Grading of Recommendations Assessment, Development and Evaluation (GRADE) for assessing the quality of evidence
- Annex 5 Pharmacology of antimalarial drugs
- Annex 6 Treatment of Plasmodium vivax, P. ovale, P. malariae and P. knowlesi infections
- Annex 7 Resistance to antimalarial medicines
The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
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