WHO Guidelines for Malaria Treatment

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Questions and Answers

When should treatment solely on the basis of clinical suspicion be considered?

When a parasitological diagnosis is not accessible (correct)

When ACTs are not available

When quinine is the only available treatment

When a parasitological diagnosis is accessible

What is the recommended treatment for uncomplicated falciparum malaria?

Artemisinin-based combination therapies (ACTs) (correct)

Quinine plus tetracycline or doxycycline

Dihydroartemisinin + piperaquine (DHA+PPQ)

Artesunate plus sulfadoxine-pyrimethamine

What is the minimum duration of treatment with an artemisinin derivative in ACTs?

2 days

5 days

3 days (correct)

7 days

What is the purpose of a single dose of primaquine in the treatment of falciparum malaria?

For its antigamecytocidal action Signup and view all the answers

What is the first step in the treatment of severe malaria?

Start full doses of parenteral antimalarial treatment without delay Signup and view all the answers

What is an alternative to artesunate in the treatment of severe malaria?

Quinine Signup and view all the answers

Why should artemisinin-based combination therapies (ACTs) be preferred over non-artemisinin based combination therapies?

Because they are more effective Signup and view all the answers

What is an option for the treatment of uncomplicated P.falciparum malaria worldwide?

Dihydroartemisinin + piperaquine (DHA+PPQ) Signup and view all the answers

What is the minimum duration for which parenteral antimalarials should be given to children in malaria endemic areas?

24 hours Signup and view all the answers

In areas with chloroquine-resistant P.vivax, what is the recommended treatment for P.vivax malaria?

ACTs with partner medicines with long-half lives Signup and view all the answers

What is the recommended dose of primaquine for radical treatment of P.vivax malaria?

0.25 – 0.5mg/kg/day Signup and view all the answers

What is the recommended treatment for P.vivax malaria in areas with chloroquine-sensitive infections?

Chloroquine + primaquine Signup and view all the answers

In severe cases of G6PD deficiency, what is the recommendation for primaquine?

Contraindicated Signup and view all the answers

What is the recommended treatment for malaria in the first trimester of pregnancy if quinine + clindamycin fails or has compliance issues?

An ACT Signup and view all the answers

What is the recommended duration of primaquine treatment in mild to moderate G6PD deficiency?

8 weeks Signup and view all the answers

What is the recommended treatment for malaria in children in areas where there is insufficient evidence to recommend one antimalarial medicine over another?

All of the above Signup and view all the answers

What is the primary vector responsible for transmitting malaria parasites?

Female Anopheles mosquitoes Signup and view all the answers

Which of the following Plasmodium species is NOT associated with the most serious forms of malaria?

Plasmodium ovale Signup and view all the answers

What is the typical fever pattern observed in patients infected with P. vivax, P. ovale, and P. falciparum?

Every other day febrile paroxysms Signup and view all the answers

Which of the following physical findings is NOT typically associated with uncomplicated malaria?

Rash Signup and view all the answers

What is the minimum temperature required to suspect malaria in a patient?

37.5°C Signup and view all the answers

Which of the following symptoms is NOT typically associated with uncomplicated malaria?

Hematuria Signup and view all the answers

What is the main purpose of the WHO Guidelines for the Treatment of Malaria?

To provide evidence-based guidelines for the formulation of policies and protocols for the treatment of malaria Signup and view all the answers

What is the scope of the MTG in terms of malaria diagnosis and treatment?

Policies and strategies for malaria diagnosis and treatment from a clinical and public health perspective Signup and view all the answers

What is the criteria for the formulation of recommendations for malaria treatment in the WHO Guidelines?

Based on evidence considering safety, efficacy, overall cost-benefit, and feasibility of implementation Signup and view all the answers

What is the recommendation for malaria diagnosis in the WHO Guidelines?

Prompt parasitological confirmation by microscopy or RDTs Signup and view all the answers

What is the scope of the WHO Guidelines for the Treatment of Malaria in terms of population groups?

Uncomplicated malaria, severe malaria, and special groups such as young children, pregnant women, and HIV/AIDS patients Signup and view all the answers

What is the release date of the 2nd Edition of the WHO Guidelines for the Treatment of Malaria?

9 March 2010 Signup and view all the answers

What is the consideration for the formulation of recommendations for malaria treatment in the WHO Guidelines?

The benefits against the risks, burden of cost, and implications for the health system Signup and view all the answers

What is the purpose of the WHO Guidelines for the Treatment of Malaria in terms of health systems?

To provide a framework for the development of specific diagnosis and treatment protocols in countries Signup and view all the answers

What is the significance of splenic enlargement in individuals living in endemic areas?

It is a frequent finding among otherwise healthy individuals Signup and view all the answers

Which of the following is NOT a sign of severe malaria?

Focal neurologic signs Signup and view all the answers

What is the primary method of diagnosing malaria?

Microscopy and rapid diagnostic tests Signup and view all the answers

What is the advantage of rapid diagnostic tests over microscopy?

They require no electricity or laboratory infrastructure Signup and view all the answers

What is the significance of parasite virulence in severe malaria?

It is one of the factors that determines the severity of malaria Signup and view all the answers

What is the characteristic of onset of cerebral malaria?

It may be gradual or sudden, following a convulsion Signup and view all the answers

What is the limitation of microscopy in diagnosing malaria?

It is labor-intensive and requires substantial training and expertise Signup and view all the answers

What is the difference between microscopy and rapid diagnostic tests in terms of results?

Microscopy provides a quantitative result, while rapid diagnostic tests provide a qualitative result Signup and view all the answers

Study Notes

WHO Guidelines for the Treatment of Malaria

The WHO Guidelines for the Treatment of Malaria (MTG) provide comprehensive, global, and evidence-based guidelines for the formulation of policies and protocols for the treatment of malaria.
The guidelines are not a clinical management manual for the treatment of malaria.
The 2nd edition of the guidelines was released in 2010 and can be accessed online.

Contents and Scope of the MTG

The guidelines cover malaria diagnosis and treatment policies and strategies from both clinical and public health perspectives.
The guidelines provide information on what to use, how to use, and where to use antimalarial medicines, including indications, contraindications, and precautions.

Formulation of Recommendations for Malaria Treatment

Recommendations are based on evidence, considering the safety, efficacy, overall cost-benefit, and feasibility of implementation.
The guidelines take into account the benefits and risks of antimalarial medicines, as well as the implications for the health system.

Current Recommendations and Updates

The guidelines provide evidence-based recommendations for the treatment of uncomplicated malaria, severe malaria, and malaria in special groups (e.g., young children, pregnant women, HIV/AIDS patients).
The guidelines also provide recommendations for the treatment of malaria in travellers and in epidemics and complex emergency situations.

Malaria Diagnosis

Prompt parasitological confirmation by microscopy or RDTs is recommended in all patients suspected of malaria before treatment is started.
Treatment solely on the basis of clinical suspicion should only be considered when a parasitological diagnosis is not accessible.

Treatment of Uncomplicated Falciparum Malaria

Artemisinin-based combination therapies (ACTs) are the recommended treatments for uncomplicated falciparum malaria.
The following ACTs are recommended: artemether + lumefantrine, artesunate + amodiaquine, artesunate + mefloquine, artesunate + sulfadoxine-pyrimethamine, and dihydroartemisinin + piperaquine.
Second-line antimalarial treatment options are also provided.

Treatment of Uncomplicated Falciparum Malaria (continued)

Artemisinin-based combination therapies should be used in preference to non-artemisinin-based combination therapies.
ACTs should include at least 3 days of treatment with an artemisinin derivative.
Dihydroartemisinin + piperaquine (DHA+PPQ) is an option for the treatment of uncomplicated P. falciparum malaria worldwide.
A single dose of primaquine (0.75mg/kg) may be used for its antigametocytocidal action in the treatment of falciparum malaria.

Treatment of Severe Malaria

Severe malaria is a medical emergency that requires prompt treatment with full doses of parenteral antimalarial treatment.
Artesunate i.v. or i.m. is recommended for adults, while quinine remains an acceptable alternative.
For children, artesunate i.v. or i.m., quinine (i.v. infusion or divided i.m. injection), or artemether i.m. are recommended.
Parenteral antimalarials should be given for a minimum of 24 hours, and then completed with a full course of an ACT or artesunate + clindamycin or doxycycline.

Treatment of Vivax Malaria

Chloroquine combined with primaquine is the treatment of choice for chloroquine-sensitive infections.
In areas with chloroquine-resistant P. vivax, ACTs (with partner medicines with long-half lives) are recommended for the treatment of P. vivax malaria.
At least a 14-day course of primaquine is required for radical treatment.

Treatment of Malaria in Special Groups

For pregnant women, quinine + clindamycin is recommended in the first trimester, while an ACT is indicated only if this is the only treatment immediately available or if treatment with quinine + clindamycin fails or compliance issues with a 7-day treatment.

What is Malaria?

Malaria is a vector-borne infectious disease that is widespread in tropical and subtropical regions.
It is caused by protozoan parasites of the genus Plasmodium.
The most serious forms of the disease are caused by P. falciparum and P. vivax.

Signs and Symptoms of Malaria

Malaria should be suspected in the setting of fever (temperature ≥37.5°C) and relevant epidemiologic exposure.
Febrile paroxysms may occur every other day for P. vivax, P. ovale, and P. falciparum, and every third day for P. malariae.
Uncomplicated malaria may present with nonspecific symptoms, including tachycardia, tachypnea, chills, malaise, fatigue, diaphoresis, headache, cough, anorexia, nausea, vomiting, abdominal pain, diarrhea, arthralgias, and myalgias.
Severe malaria may present with altered consciousness, respiratory distress, circulatory collapse, metabolic acidosis, renal failure, hepatic failure, coagulopathy, and severe anemia or massive intravascular hemolysis.

Diagnosis of Malaria

The diagnosis of malaria is established in the setting of symptoms consistent with malaria and a positive malaria diagnostic test.
Clinical tools for parasite-based diagnosis include microscopy and rapid diagnostic tests (RDTs).
Microscopy allows identification of the Plasmodium species as well as quantification of parasitemia.
RDTs are increasingly important diagnostic tools in resource-limited endemic settings due to their accuracy and ease of use.

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Description

This quiz is about the WHO Guidelines for the treatment of malaria, providing evidence-based guidelines for policymakers and healthcare professionals. It covers the formulation of policies and protocols for malaria treatment.