International Guidelines for Malaria Prophilaxis & Treatment

INTERNATIONAL GUIDELINES  for  MALARIA  PROPHYLAXIS & TREATMENT

Preface

The first draft of this manual was written during may missions at the Albert Schweitzer hospital in Lambarene and during the civil war in the Horn of Africa and Tchad.

In these and many other sub Saharan countries I had the opportunity to note that to much people die due to inappropriate diagnosis and/or treatment of the malaria infection.

Malaria is most important parasitic disease of man. More than 2000 million people are exposed to varying degrees of malaria risk in some 100 countries of the tropics and approximately 270 million suffer from the infection. Malaria has been estimated to cause 3 million deaths each year, most of them in Africa and many of them children - one every 12 seconds!

Pregnant women could be magnets for blood-sucking insects putting them at higher risk of contracting the infection than their non-pregnant sisters. Malaria is a major cause of illness and death during pregnancy, particularly in their first pregnancy.

No effective vaccines have yet been developed.

The human disease is a protozoan ( Gr. protos - primitive, zoon - animal ) infection of red blood cells transmitted by the bite of a mosquito; a microscopic single-celled animal not to be confused with a bacterium which belongs to the plant kingdom. Four species of human malarial parasites with different individual characteristics are transmitted by some very efficient species of anopheline mosquitoes. The most serious infection is caused by the Plasmodium falciparum and it may be fatal if untreated. Especially in high risk groups such as pregnant women and young children. With P. vivax, P. ovale and P. malariae (the less virulent) severe disease is unusual.

Malaria parasites are older than humankind. They have accompanied the evolution of primates throughout the geological ages from their earliest ancestors up to the emergence of humans. The parasites too underwent adaptive changes and it is believed that the P. falciparum, which causes the fatal form of human malaria, is the latest evolved species of the parasite which the benign P. malariae, the oldest on the scale of evolution, may have been the first to invade humans.

There are about 400 species of anopheline mosquitoes but nearly 45 are considered important vectors which differ considerably in their natural abundance, feeding, flight ranges and choice of blood source.

Malaria was a major factor in Vietnam War, US soldiers lost more combat days from malaria infection than from battle injuries.

Most malaria in the world is either untreated or treated inadequately by self-medication. Education of the public sector and the private commercial sector is vitally important. Coherent and efficient schemes for drug purchase and distribution are essential.

It is may hope that this manual will gain wide acceptance and application and that an improved understanding of malaria aetiology, prophylaxis and treatment will contribute to strengthening health care in the tropics.

   A. M. Sancin

CONTENTS

Preface

Acknowledgements

Introduction

Why study malaria ?
                               Who will use this manual ?
                               How this manual is organised

Commonly used abbreviations

Section  A.     General Informations for Medicine Doctors and Travellers

  1. The killer
  2. Anti mosquito measures
    • Introductive  note
    • Mechanical protection
    • Chemical protection
  1. Information Box 1: Advice to be given by prescribers to pregnant women & women of childbearing  potential
  2. Information Box 2: Advice to be given by prescribers to the parents of young children, breast-feeding & breast- fed infants
  3. Information Box 3: Advice to be given by prescribers to those intending to stay in a malarious area for over one month
  4. Information Box 4: Special situations, multidrug - resistant malaria
  5. Information Box 5: Return from the tropics 

Section  B.    Adults and Paediatric Prophylactic & Stand-by Treatment Dosages

  1. Schedule 1: Antimalarial drugs -Adults prophylactic dosages
  2. Schedule 2: Antimalarial drugs -Adults stand-by treatment dosages
  3. Schedule 3: Antimalarial drugs - Paediatric prophylactic dosages
  4. Schedule 4 : Antimalarial drugs - Paediatric treatment dosages

Section  C.    Uncomplicated Malaria

  1. Aetiology
  2. Clinical features
  3. Laboratory findings
  4. General management

Section  D.    Severe & Complicated Malaria in Adults

  1. Aetiology
  2. Definition
  3. Clinical features
  4. General management

Section  E.     Clinical Features & Management of Complications

  1. Anaemia
  2. Cerebral malaria
  3. Circulatory collapse
  4. Fluid space, Electrolyte, Acid-Base changes
  5. Hyperparasitaemia
  6. Hyperpyrexia
  7. Hypoglycaemia
  8. Malarial haemoglobinuria
  9. Pulmonary oedema
  10. Renal failure
  11. Spontaneous bleeding, Disseminate Intravascular Coagulation (DIC)  

Section  F.     Severe & Complicated Malaria in Children

  1. Anaemia
  2. Cerebral malaria
  3. Dehydration
  4. Hypoglycaemia
  5. Severe malaria

Section  G.    Severe & Complicated Malaria in Pregnancy

  1. Anaemia
  2. Hypoglycaemia
  3. Pulmonary oedema
  4. Severe malaria

Section  H.    Treatment of Severe P. falciparum Malaria in Adults & Children

  1. Chemotherapy of Chloroquine Resistant  P. falciparum malaria strains
    • Interactions
    • Resistance
    • Pregnancy
    • Intensive Care
  2. Chemotherapy of Chloroquine Sensitive P. falciparum malaria strains
    • Indications
    • Benign malaria
    • Total cumulative dose
    • 4 - aminoquinolines treatment characteristics
    • Pregnancy
    • Allergic reactions
    • Stomach discomfort
  3. General informations in malaria prophylaxis & treatment
  4. Common diagnostic & management errors
  5. Prognostic indicators
    • Clinical indicators
    • Laboratory indicators

Section  I.      Antimalarial Drugs

  1. Notes on main antimalarial drugs characteristics
  2. Antimalarial drug interactions
  3. Emergency Treatment & Intensive care in case of over-dose, poisoning with antimalarial drugs
  4. International  antimalarial drug directory

Section  J.     Management of Antimalarial Drugs within Different Conditions

  1. Hepatic failure in malaria prophylaxis and treatment
  2. Renal failure in malaria prophylaxis and treatment
  3. Pregnancy in malaria prophylaxis and treatment
  4. Breast-feeding in malaria prophylaxis and treatment
  5. Contraception in malaria prophylaxis and treatment
  6. Complications in Surgery

Section  K.    Cost of Course of Treatment with Antimalarial Drugs

  1. Introductive note
  2. Cost of course of treating acute attack
  3. Cost of one month of prevention

Section  L.     Geographical Aspects

  1. World malaria chart
  2. Malaria free countries

Section  M.    Appendix

  1. Current use of antimicrobial agents in the therapy of infections
  2. Guide to Intravenous Fluid & Electrolyte Replacement Therapy
  3. Prescribing for children
  4. Determination of Body Surface Area in Adults and Children
  5. Glossary

Further Reading

Index

Blue Cards (See blue forms inside this cover)

  1. What to report?
  2. How to report ?