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Guidelines for the treatment of malaria – 2 edition

3. objectives of treatment

3.1 uncomplicated malaria

The objective of treating uncomplicated malaria is to cure the infection as rapidly as
possible. Cure is defined as the elimination from the body of the parasites that caused the
illness. This prevents progression to severe disease, and additional morbidity associated
with treatment failure. In treatment evaluations, it is necessary to follow patients for
sufficient time to appropriately assess cures (see Section 5.1).

The public health goal of treatment is to reduce transmission of the infection to others, i.e.
to reduce the infectious reservoir and to prevent the emergence and spread of resistance
to antimalarial medicines (see Annex 4). The adverse effect profile and tolerability
of antimalarial medicines, and the speed of therapeutic response are also important
considerations.

3.2 severe malaria

The primary objective of antimalarial treatment in severe malaria is to prevent death.
In treating cerebral malaria, prevention of neurological deficit is also an important
objective. In the treatment of severe malaria in pregnancy, saving the life of the mother
is the primary objective. In all cases of severe malaria, prevention of recrudescence and
avoidance of minor adverse effects are secondary.

4. resistance to antimalarial medicines

Resistance to antimalarial medicines has been documented in all classes of antimalarials,
including the artemisinin derivatives, and it is a major threat to malaria control.
Widespread and indiscriminate use of antimalarials exerts a strong selective pressure
on malaria parasites to develop high levels of resistance. Resistance can be prevented,
or its onset slowed considerably, by combining antimalarials with different mechanisms
of action and ensuring very high cure rates through full adherence to correct dose
regimens. Further information on the emergence, spread and prevention of resistance
to antimalarials is provided in Annex 6.

1 Methods for surveillance of antimalarial drug efficacy. Geneva, World Health Organization, 2009.
http://apps.who.int/malaria/docs/drugresistance/Protocol2009.pdf, accessed 29 October 2009).
2 Methods and techniques for clinical trials on antimalarial drug efficacy: genotyping to identify parasite populations.
Informal consultation organized by the Medicines for Malaria Venture and cosponsored by the World Health
Organization, 29–31 May 2007, Amsterdam, the Netherlands. Geneva, World Health Organization, 2008
http://apps.who.int/malaria/docs/drugresistance/MalariaGenotyping.pdf, accessed 29 October 2009).
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