guidelines for malaria treatment

ABSTRACT
The control of malaria continues to be a major challenge in South Africa.  About 10 000 cases were notified in 1995 and already over 22 000 cases during the first half of 1996. Although the increase was mainly due to favourable climatic conditions, resistance of the malaria parasites to drugs and the increasing number of imported cases aggravate the situation.

These guidelines are issued by the SA Department of Health.

The objective is to provide all those involved in the diagnosis and treatment of malaria with a clear and practical guide.

The outcome aimed for is higher awareness of malaria resulting in a higher suspicion of malaria infections which would contribute to timeous diagnosis and appropriate treatment.

The basis for these guidelines is the World Health Organisation's guidelines for the treatment of malaria.  Extensive literature surveys have been undertaken and all available widely used treatment regimes were considered.  The efficacy, safety and impact on resistance emergence patterns of the various therapeutic options were evaluated.

The development of these guidelines was initiated by the Department of Health and the national Malaria Advisor by Group (MAG).  The Subcommittee of Chemoprophylaxis and Therapy (SCAT) of the MAG consisting of experts in malaria was responsible for the compilation of the guidelines.  The members of the SCAT are Dr Frank Hansford, Department of Health (Chairperson); Dr Karen Barnes, Department of Pharmacology, University of Cape Town; Ms Elske Smith, Roche Ethical Assistance Line, University of Cape Town; Dr Lucille Blumbergh, Department of Microbiology, South African Institute for Medical Research; Mr\s Lee Baker, Transvaal Pharmaceutical Society Drug Information Centre; Dr Dirk van den Bergh, Department of Internal Medicine, 1 Military Hospital AND Drs Andrew Ross and Harvey Williams, Mosvolt Hospital, Kwazulu-Natal.

The draft guidelines were also subjected to review by Dr Dave Durrheim, Department of Health, Welfare and Gender Affairs, Mpumalanga Province; Dr Gary Maartens, Department of Medicine, University of Cape Town and Dr Jan van den Ende, Department of Microbiology, De Buisson and Partners (Chairperson of the MAG).  The final concept was compiled by Ms Danette Lombaard, Directorate for Communicable Disease Control, Department of Health, in collaboration with the SCAT.

The contents deal with the objectives of malaria treatment, the parasites and risk groups involved, methods for the diagnosis of malaria and the treatment of uncomplicated malaria and sever and complicated malaria.  The treatment of the four Plasmodium species infecting man and the treatment of specific individuals such as pregnant women, infants and young children are also discussed. The treatment regimes are provided in table form and the most important adverse effects of the drugs are mentioned.

The treatment regimes are summarised in a diagram for easy reference. For uncomplicated malaria, sulfadoxine-pyrimethamine, quinine or chloroquine are recommended. For severe and complicated malaria, quinine plus either doxycycline or sulfadoxine-pyrimethamine are recommended and if no response is obtained, halofantrine, mefloquine or artemisinin.

The guidelines are endorsed by the Medical Association of South Africa.

Compiled by the Department of Health in collaboration with the Subcommittee for Chemoprophylaxis and Therapy of the National Malaria Advisory Group.
October 1996