WHO's updated malaria guidelines include rapid diagnosis, new ACT

The WHO on Tuesday released new guidelines for the treatment of malaria, which recommend "parasitological testing before treatment begins" and add "a new artemisinin based combination treatment [ACT] to the list of prescribed drugs," BMJ News reports. According to BMJ News, WHO's guidelines are "expected to enhance earlier and accurate diagnosis, halt the emergence of drug resistance, and reduce the use of unnecessary treatment" (Zarocostas, 3/9).

Agence France-Presse reports that the guidelines aim "to expand combination or multiple drug therapy and halt single drug use that is helping the parasite develop resistance to the new treatment artemisinin." Robert Newman, director of the WHO's Global Malaria Program, said, "It is critical that we work with countries to procure high quality medicines, because the use of medicines with sub-standard quality - counterfeits and monotherapies - is terribly dangerous." He told journalists, "There is likely no greater global threat to the future success of malaria control than resistance to artemisinin" (3/9).

The WHO's "second edition of the Guidelines for the Treatment of Malaria provides evidence-based recommendations for countries on both diagnosis and treatment." The "main" differences between this issue and the 2006 one, "are the emphasis on testing before treatment and the addition of a new ACT to the list of recommended treatments," according to the U.N. News Centre (3/9).

VOA News reports that only "22 percent of suspected malaria cases were tested in 18 of 35 African countries" in 2008, according to the WHO (Schlein, 3/9). "Until now, most clinics had to rely on microscopy, but the recent development of quality-assured Rapid Diagnostic Tests (RDTs) using a dip stick and a drop of blood means a policy change is possible," according to a WHO press release. "The tests can reliably demonstrate the presence or absence of malaria parasites in the blood and can be performed at all levels of the health system, including community settings" (3/9).

Testing all suspected malaria cases "will ensure, not only, that those who receive artemisinin-combination medicines really have malaria, but will also allow health care workers to exclude malaria and look for other causes of fever in those who do not have malaria," according to the WHO's Newman. "It will take some time to achieve the goal of universal diagnostic testing for malaria … But, in the end, it will be worth it. Not only will we do a better job of treating patients, but, we will be helping to prevent the potential spread of resistance to artemisinins, our most important class of medicines for treating malaria," he said, VOA News reports (3/9).