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Guidelines for the treatment of malaria – 2 edition

Whenever this strategy is adopted, a full treatment course should always be given.
Mass fever treatment must not be confused with mass drug administration (i.e. the
administration (see Section 13).

11.3 areas prone to mixed falciparum/vivax malaria epidemics

During mixed falciparum/vivax malaria epidemics, ACTs (except artesunate plus
sulfadoxine-pyrimethamine) should be used for treatment as they are highly effective
against all malaria species.

11.4 areas prone to vivax malaria epidemics

In areas with pure P. vivax epidemics, and where drug resistance has not been reported,
chloroquine is the most appropriate medicine once the cause of the epidemic has been
established. Resistance of P. vivax to chloroquine has been reported from Oceania and
South-East Asia, but it is probably limited in distribution. Though there is insufficient
knowledge at present to allow specific recommendations to be made for treatment of
P. vivax epidemics in areas of suspected resistance,

11.5 anti-relapse therapy in vivax malaria epidemics

The 14-day anti-relapse therapy for vivax malaria is impractical in most epidemic
situations because of the duration of treatment and poor compliance. Moreover, it is not
an effective strategy as long as the risk of re-infection is high. If adequate records are
kept, anti-relapse therapy can be given in the post-epidemic period to patients who have
previously been treated with blood schizonticides. Primaquine 0.25–0.5 mg base/kg body
weight in two divided daily doses should be given for 14 days, as there is no evidence
that shorter courses are effective. Appropriate health education should be provided to
encourage adherence in situations where primaquine is given without supervision.

11.6 management of severe falciparum malaria

Management of severe P. falciparum malaria in epidemic situations will often take place
in temporary clinics or in situations in which staff shortages and high workloads make
intensive case monitoring difficult. Drug treatment should, therefore, be as simple and
safe as possible, with simple dosing schedules and minimal need for monitoring the
treatment. Intramuscular artemether with its simple one-a-day regimen and ease of
administration is an attractive treatment option in overburdened epidemic situations,
despite the concern about its erratic absorption. In comparison, the current artesunate
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