Are national treatment guidelines for falciparum malaria in line with WHO recommendations and is antimalarial resistance taken into consideration? – A review of guidelines in non‐endemic countries

Abstract

Objective Plasmodium falciparum infections are a relatively rare but potentially deadly disease found in returning travellers. We compare the national treatment guidelines of non‐endemic countries with the WHO guidelines for the treatment of Plasmodium falciparum infections. Methods Review. We identified non‐endemic countries with an incidence rate of imported malaria of at least one per 100,000 population and at least 50 cases annually. Using PubMed and Google Search, we reviewed national guidelines published before 1 March 2021. Results Thirteen guidelines were identified. For uncomplicated falciparum malaria, 11 of 13 countries (85%) recommend an artemisinin‐based combination therapy as first‐line regimen in adults, of which artemether–lumefantrine was the most common. For severe malaria, all guidelines recommend the use of intravenous artesunate. Only three countries adjust treatment recommendations based on expected artemisinin resistance. Conclusion Treatment guidelines for uncomplicated falciparum malaria in non‐endemic countries generally adhere to WHO recommendations but often fail to mention the risk of drug resistance in returning travellers. Artemisinin‐based Combination Therapies (ACTs) should be the first choice for all uncomplicated malaria cases. Furthermore, the choice between ACTs should be based on regional resistance patterns.

Chloroquine-Induced Psychosis: A Case Report

“…To treat malaria, the WHO recommends artemisinin-based combination therapies (ACTs). They are considered the first and second lines of treatment because alternative antimalarial drugs such as chloroquine, doxycycline, and quinine have significantly more side effects [ 5 ]. Other options as approved by CDC guidelines include atovaquone-proguanil as prophylaxis in the military population.…”

Diagnosis and Treatment of Malaria in Nigeria

“…The gold standard for detecting malaria is microscopy, an established and very easy technique that offers a highly sensitive malaria-specific diagnosis and can quantify malaria parasites and identify infecting species [13]. Through a chemical procedure known as staining, parasites can be successfully located and recognized visually under a microscope.…”

“…Giemsa staining reveals parasites, white blood cells, platelets, and other artifacts while only slightly staining red blood cells. Thin and thick malaria smears can be taken in any laboratory that can perform basic hematology testing [13], and trained microscopists can find asexual parasites at a density of less than 10/L of blood [13].In addition to identifying patients with active malaria, microscopy can also provide details on the density of the parasites, which can be used to track treatment effectiveness. The subjective identification and counting of parasites by microscopists, the dearth of skilled microscopists and dependable equipment in many malaria-endemic countries like Nigeria, and the difficulty of an unpredictable power supply are some drawbacks of microscopy, though [9].…”

“…Figure 3 shows the SHERLOCK diagnostic workflow. 1) Human serum, whole blood, or DBS samples go through a 10-min S-PREP protocol in which the sample is suspended in 20% (wt/vol) Chelex-100 in TE buffer with 50 mM DTT and incubated at 95 °C for 10 min; and 2) the suspended sample is transferred to lyophilized SHERLOCK pellet followed by incubation at 40 °C for 60 min before endpoint analysis via fluorescence or lateral flow strip [13].…”

Evaluation of the effect and mechanism of artemether against Toxoplasma gondii

“…Artemether is a sesquiterpene lactone compound, which is artemisinin-based semisynthetic compound, and is usually used in combination with artemisinin as a rst-line agent for the treatment of malaria (Boateng-Marfo et al 2021). The World Health Organization (WHO) recommends an artemisinin derivative combined with a general antimalarial drug for the treatment of Plasmodium falciparum (Visser et al 2022). Moreover, many studies shows that artemisinin derivatives have antiviral, antifungal, anticancer, and antidiabetic activities (Buragohain et al 2015;Sun et al 2019;Wong et al 2017).…”