Recommamdations Laos, Vietnam, Cambodge

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Recommamdations Laos, Vietnam, Cambodge

Paludisme 2005

Recommandations nationales

Laos, Vietnam, Cambodge

NH.Tuan IFMT Séminaire du

paludisme Déc. 2005

1


Laos

National Policy for Malaria Diagnosis and

Treatment

1. Use Guidelines

for diagnosis and treatment

at all levels

2. Diagnose and treat

together

2


• Decision chart for malaria treatment (Laos)

3


• Lao national guidelines for treatment :

– P. Falciparum :

• Coartem to be used as the first line treatment

• Quinine+doxycycline to be used as second line treatment

in case Coartem failure

– P.Vivax :

• Chloroquine followed by primaquine

• Primaquine : to prevent relapses

• Primaquine : not recommended for P. falciparum

due to G6PD high prevalence in Lao people

4


• Prophylaxie :

• Différents groups :

– Voyageurs, expatriés venant de zone non endémique

– Femmes enceintes

– Personnes venantes de zone non endémique

– Enfants

• Médicaments recommandés :

– Doxycycline (Contraindicated in pregnant women and

children < 8 years)

– Mefloquine

5


Vietnam : Stratégies

1. Renforcer le service de santé au niveau des villages

et communes, groupes mobiles de district & gestion

de secteurs privés.

2. Distribuer le guide national de traitement à chaque

region et niveau.

3. Multiplier les sites de microscopie et développer

l’usage de TDRs.

4. Améliorer la qualité diagnostique & thérapeutique,

traitement spécial de cas sevère.

7


Stratégies

5. Surveiller l’efficacité des anti-malariques,

rechercher de nouveaux médicaments,

mettre à jour politique et gestion des médicaments.

6. Production de l’Artemisinine & derivés à large échelle.

Promotion des combinaison anti-malariques (ACT).

7. Fournir anti-malariques gratuitement et suffisamment.

8. Management de qualité & distribution des

médicaments.

8


Vietnam:

Treatment guidelines

for malaria

9


Usage des anti-paludiques

• Traitement de cas : Confirmé et suspecté

• Treatment de masse: épidemie/outbreaks areas only

• Prophylaxie : Personne à risque temporaire du

malaria : Visiteurs, nouveaux immigrants/ migrant,

commercants/missionnaires.

• Stand-by: Personnes entrées dans zone endémique

(sans service de santé)

10


Vietnam: recommandations progr. national

Drogue Durée Indication

1èr choix

CQ ou Artesunate 7 j cas suspecté

Artesunate

7 j P.f.

ou CV8 **

3 j

CQ 3 j P.v

2ème choix

Artesunate + Mefloquine

ou autre ACT

3 j

3j

Quinine 7 j P.f

CQ + Primaquine 3 j P.v

P.f confirmé

** CV8 = DHA + PIP + TRI + PQ

11


Vietnam: efficacité comparée CV8 vs Malarone

12


Current Anti-malarial essential Drugs & used levels

Name of drug

Central &

prov. levels

District

level

Commune

level

Village

level

Chloroquin (tablet) + + + +

Artesunate (tablet) + + + +

Artesunate (supp.) + + + +

Artesunate (inject.) + + +

Primaquine (tablet) + + +

Quinin (tablet) + + +

Quinine (inject.) + + +

CV-8 (tablet) + + +

Mefloquine (tablet) + +

13


Treatment in various levels

Type of

patient

Central

prov.

hosp.

Dist.

hosp.

Comm.

Health

center

Village

Health

Worker

Private

sector

Common + + + + +

Pregnancy + + + +

< 15 age + + + + +

Severe + + Give

first aid

Give

first aid

Give

first aid

14


Selection of drugs for treatment

Patient Suspected P.falci P.vivax Mixed

< 3 age ASU or CQ ASU CQ ASU

> 3 age ASU or CQ ASU + PRI.

or CV8

Pregnancy

< 3 months

Pregnancy

> 3 months

CQ + PRI ASU +

PRI

CQ QUI CQ QUI

AS or CQ AS CQ ASU

15


Anti-malaria drugs made in Viet Nam

Artemether 300 mg – diluted powder

formulation (Erapas)

** CV8 = DHA + PIP + TRI + PQ

Source : http://www.actmalaria.org/index.php3?page=drugpolicies 16


Anti-malaria drugs made in Viet Nam

Source : http://www.actmalaria.org/index.php3?page=drugpolicies

17


Drug resistance:

Challenges and solutions

18


Challenges

1. Artesunate alone gives high rate of recrudescence.

2. Mefloquine is expensive & has side effects

3. combination treatment is difficult for in large scale

4. Movement of people has spread drug resistant P.falciparum

5. In remote areas, lack of knowledge diagnosis/treatmt of HWs

19


Solutions =

1. Use ACT :

CV8, Arterakin….which are

• short course (3 days)

• highly effective

• safe : few side effect

• cheap.

2. Supervision, evaluation and upgrade the training.

3. Develop microscopic points.

4. Research and application of quick tests.

20


Cambodia national

Objectives :

anti-malaria drug policy

1. Create and maintain

– access to early diagnosis and treatment

– effective, safe & good quality drugs

2. Minimize selection pressure for drug resistance.

22


3. Parasitological cure to reduce reservoir of infection.

4. Use malaria national treatment guideline

based on WHO Malaria recommendations

23


Anti-malaria drug combinations

recommended in Cambodia

- Use National Treatment Guideline for Malaria

(NTGM)

- NTGM are combination based, developed in 2000

- Combinations are :

1. Artesunate + Mefloquine = first line treatment

2. Quinine + Tetracycline = 2 nd line

24


Références

Laos Centre of Malariology, Parasitology & Entomology (Dr Rattanaxay

PHETSOUVAVANH)

• The Laos National Policy for Malaria Diagnosis and Treatment (Dr Mayfon

Mahosot Hospital)

• http://actmalaria.org/index.php3?page=drugpolicies

• http://actmalaria.org/index.php3?page=infosharing

• http://rbm.who.int/wmr2005/

• CNM of Cambodia online (http://www.cnm.gov.kh/programs.htm)

• Who guideline on malaria

• World malaria report 2005

• Pubmed : CV8, a new combination of dihydroartemisinin, piperaquine,

trimethoprim and primaquine, compared with atovaquone-proguanil

against falciparum malaria in Vietnam.

26

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