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The Use of Antimalarial Drugs THE USE OF ANTIMALARIAL DRUGS THE USE OF ANTIMALARIAL DRUGS Report of an Informal Consultation World Health Organization, Geneva WHO, 2001 Technical Review: A. Bosman, C. Delacollette, P. Olumese, R. G. Ridley, A. Rietveld R. Shretta, A. Teklehaimanot Text editor: S. Poole Layout and production: WHO & Graficim Cover photo courtesy of H. Anenden The authors wish to recognise the contributions made to the writing of this report at country level by Ministries of Health and other partners, Regional Offices of WHO, and at a global level by mission reports, partners and the RBM team. Roll Back Malaria World Health Organization 20, avenue Appia CH-1211 Geneva 27, Switzerland Tel: +(41) 22 791 3606, Fax: +(41) 22 791 4824, E-mail: [email protected] Web site: http://www.rbm.who.int/ WHO/CDS/RBM/2001.33 © Copyright 2001 by Roll Back Malaria/World Health Organization This document is not a formal publication of the World Health Organization and all rights are reserved by the organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale nor for use in conjunction with commercial purposes. The designation employed and the presentation of the material in this publication, including maps and tables do not imply the expression of any opinion whatsoever on the part of the secretariat of the World Health Organization concerning the legal status of any country, territory, city or area of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or 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 omission excepted, the names of proprietary products are distinguished by initial capital letters. Report of an informal consultation, WHO, Geneva, 13–17 November 2000 CONTENTS Introduction ...............................................................................................................................................................................................................................................................................................................5 PART I – POLICY IMPLICATIONS 1. Current status of antimalarial drug resistance ............................................................................................................................................................................................8 1.1 Development of resistance.......................................................................................................................................................................................................................................8 1.2 Assessment of antimalarial drug susceptibility ..........................................................................................................................................................................9 1.3 Plasmodium falciparum resistance .............................................................................................................................................................................................................10 1.4 Plasmodium vivax resistance..............................................................................................................................................................................................................................12 1.5 Regional responses to antimalarial drug resistance.........................................................................................................................................................12 2. Combination therapy..................................................................................................................................................................................................................................................................17 2.1 Definitions...................................................................................................................................................................................................................................................................................17 2.2 Rationale for the use of combination therapy.......................................................................................................................................................................17 2.3 Artemisinin-based combination therapy........................................................................................................................................................................................18 2.4 Implementation of combination therapy – operational issues.....................................................................................................................20 3. Chemoprophylaxis and treatment of malaria in special groups..................................................................................................................................20 3.1 Chemoprophylaxis and intermittent treatment of malaria in pregnancy....................................................................................20 3.2 Chemoprophylaxis and stand-by treatment in travellers ......................................................................................................................................21 3.3 Management of severe malaria......................................................................................................................................................................................................................24 3.4 Vivax malaria ...........................................................................................................................................................................................................................................................................24 3.5 Formulations for paediatric use ...................................................................................................................................................................................................................24 4. Antimalarial treatment policies.....................................................................................................................................................................................................................................25 4.1 Definition......................................................................................................................................................................................................................................................................................25 4.2 Purpose..............................................................................................................................................................................................................................................................................................25 4.3 Development............................................................................................................................................................................................................................................................................26 4.4 Factors influencing antimalarial treatment policies .......................................................................................................................................................27 4.5 Health-seeking behaviour .....................................................................................................................................................................................................................................32 4.6 Criteria for changing treatment policy .............................................................................................................................................................................................33 4.7 Process of changing treatment policy: country examples .....................................................................................................................................34 4.8 Implementation and access to antimalarial drugs in endemic countries ......................................................................................38 5. Conclusions and recommendations ......................................................................................................................................................................................................................39 5.1 General..............................................................................................................................................................................................................................................................................................39 5.2 Future research and other activities........................................................................................................................................................................................................41 PART II – ANTIMALARIAL DRUGS 1. Antimalarial drugs for malaria prevention and treatment ...................................................................................................................................................43
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