Page 15 - 80 guidelines for the treatment of malaria_opt

1. Introduction

1. introduction

1.1 background

Malaria is an important cause of death and illness in children and adults, especially in
tropical countries. Malaria control requires an integrate approach, including prevention
(primarily vector control) and prompt treatment with effective antimalarials. Since the
publication of the first edition of the guidelines in 2006, most of the countries where
P. falciparum is endemic have progressively updated treatment policies from the failing
chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) to the recommended artemisinin-
based combination therapies (ACTs); this is the best current treatment for uncomplicated
falciparum malaria. Unfortunately, the implementation of these policies has lagged behind
due to various factors such as high costs.

The recommendations given in these guidelines aim to provide simple and straightforward
treatment recommendations based on sound evidence that can be applied even in
severely resource-constrained settings. To achieve this goal, all relevant factors are taken
into account with adjustments for different areas where levels of drug resistance and
background immunity vary. These factors include the in vitro antimalarial susceptibility
and the pharmacokinetic and pharmacodynamic properties of the different antimalarial
medicines. Cost is a factor that should be taken into consideration in antimalarial
treatment policy and practices. However, as there are increasing international subsidies
for antimalarials, efficacy and safety have taken precedence over costs when making the
recommendations. The number of antimalarial drug trials published has continued to
increase over the years, with the result that these guidelines have a firmer evidence base
than previous treatment recommendations. Inevitably, there are still information gaps,
so they will remain under regular review with updates every two years and/or on an ad
hoc basis as new evidence becomes available. The malaria treatment recommendations
in the main document are brief; for those who may wish to study the evidence base in
more detail, a series of annexes with linkages to the appropriate sections of the main
document is provided.

1.2 objectives and target audience

1.2.1 Objectives
The purpose of these guidelines is to provide global, evidence-based recommendations
on the treatment of malaria. Information is shown on the treatment of:
■ uncomplicated malaria, including disease in special risk groups (young children,
pregnant women, people who are HIV positive, travellers from non-malaria endemic
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