CLASSIFICATION OF

TREATMENT OUTCOME
• Early Treatment Failure (ETF)
• Late Treatment Failure (LTF)
• Adequate Clinical Response (ACR)
• Late Parasitological Failure (LPF)
• Adequate Clinical and Parasitological
Response (ACPR)
DEFINITION OF TREATMENT
OUTCOME TERMS
EARLY TREATMENT FAILURE
• Development of danger signs of severe malaria
on D1, 2 or 3 in the presence of parasitaemia
• Axillary temperature ≥37.5oC on D2 with
parasitaemia > count on D0
• Axillary temperature ≥37.5oC on D3 in the
presence of parasitaemia
• Parasitaemia on D3 > 25% of count on D0
DEFINITION OF TREATMENT
OUTCOME TERMS
LATE TREATMENT FAILURE
1. Development of danger signs or severe malaria
in the presence of parasitaemia on any day from
D4 –D14 without previously meeting any of the
criteria of early treatment failure (ETF).
2. Axillary temperature ≥37.5oC in the presence of
parasitaemia on any day from D4 – D14, without
previously meeting any of the criteria of early
treatment failure (ETF).
 DEFINITION OF TREATMENT
OUTCOME TERMS
ADEQUATE CLINICAL RESPONSE
• Absence of parasitaemia on D14, irrespective of
axillary temperature
• Axillary temperature <37.5oC, irrespective of the
presence of parasitaemia,
Without meeting any of the criteria for early or late
treatment failure.
 DEFINITION OF TREATMENT
OUTCOME TERMS
LATE PARASITOLOGICAL FAILURE

• Presence of parasitaemia on Day 14 and axillary

temperature <37.5oC, without previously meeting
any of the criteria of early or late treatment
failure.
DEFINITION OF TREATMENT
OUTCOME TERMS
ADEQUATE CLINICAL AND
PARASITOLOGICAL RESPONSE
• Absence of parasitaemia on Day 14
irrespective of axillary temperature
without previously meeting any of the
criteria of early or late treatment failure or
late parasitological failure.
Table 5a: Study Outcome – Chloroquine

Calabar Enugu Ibadan Jos Kaduna M’duguri

Number 44 54 44 47 53 59
analysed

ETF – No. 10 27 9 1 3 5
% 22.7 50 20.5 2.1 5.7 8.5

LTF - No. 12 2 7 8 6 3
% 27.3 3.7 15.9 17.0 11.3 5.1

ACR– No. 22 25 28 38 44 51
% 50 46.3 63.6 80.9 83.0 86.4

LPF - No. 18 23 10 13 3 21
% 40.9 42.6 22.7 27.7 5.7 35.6

ACPR-No 4 2 18 25 41 30
% 9.1 3.7 40.9 53.2 77.3 50.8
Table 5b. Study outcome – Fansidar

Calabar Enugu Ibadan Jos Kaduna M’duguri

Number 47 47 45 52 52 54
Analysed

ETF – No. 10 17 2 3 2 2
% 21.3 36.2 4.4 5.8 3.8 3.7

LTF – No. 6 2 2 1 1 3
% 12.8 4.3 4.4 1.9 1.9 5.6

ACR– No. 31 28 41 48 49 49
% 65.9 59.6 91.1 92.3 94.2 90.7

LPF – No. 27 21 7 5 0 14
% 57.4 44.7 15.6 9.6 0 25.9

ACPR-No 4 7 34 43 49 35
% 8.5 14.9 75.6 82.7 94.2 64.8
 SUMMARY OF RESPONSES %
Chloroquine Fansidar
Calabar <75 <75
Enugu <75 <75
Ibadan <75 >75
Jos <75 >75
Kaduna >75 >75
Maiduguri <75 <75
 MONITORING T.E. OF
ANTIMALARIAL DRUGS
ISSUES:
2. Who does the monitoring?
• Special research teams
• Research teams within the control program
• Local healthcare personnel
6. Where?
• Rural health facility
• District general hospital
• Multicentre
 MONITORING T.E. OF
ANTIMALARIAL DRUGS
ISSUES
2. What to do with the results?
• To modify treatment policy: when and how?
4. Yet unmet need?
• System to monitor sensitivity to treatment in
individual cases in areas with moderate resistance
to chloroquine.
 DEVELOPMENT OF
CLINICAL TRIAL NETWORK
• Need for comparable studies of
antimalarials in different areas (with
different patterns of transmission)
• Shortage of trained personnel, testing sites
and data handling skills
• Need for studies under different conditions
(home, clinic, hospital)
 COMBINATION THERAPY
(CT) FOR MALARIA
• T.E. is enhanced due to synergistic or
additive effects of two drugs.
• Delay in the development of resistance to
the individual drugs.
 COMBINATION THERAPY
FOR MALARIA
CHARACTERISTICS:
• Can be two or more drugs each with
detectable malarial blood schizontocidal
action
• Different modes of action and biochemical
targets
Hence CQ plus chlorpheniramine and S-P are
not examples of CT.
 COMBINATION THERAPY
FOR MALARIA
Non-artemisinin based combinations
• Chloroquine plus S-P
• Amodiaquine plus S-P
• Mefloquine plus S-P
• Atovaquone plus proguanil (Malarone)
• Quinine plus tetracycline or doxycycline
 COMBINATION THERAPY
FOR MALARIA
Artemisinin-based combinations
• Artesunate plus chloroquine
• Artesunate plus amodiaquine
• Artesunate plus S-P
• Artesunate plus mefloquine
• Artemether-lumefantrine (Coartem)
 ADVANTAGES OF ACT
• Rapid massive reduction in parasite
biomass
• Rapid resolution of clinical features
• High activity against multi-resistant Pf
• Reduction of gametocyte load; may reduce
transmission in low transmission areas
• Full sensitivity so far in most places
• Well tolerated