Management of severe <i>Plasmodium falciparum</i> malaria in adults: A review of national and regional guidelines and their adherence to World Health Organization guidelines

Abstract

BACKGROUND: Plasmodium falciparum is the most prevalent and pathogenic malaria parasite associated with severe illness and death. In nonendemic countries like the Russian Federation, P. falciparum malaria is a relatively rare but potentially fatal disease found in travelers returning from countries with high malaria burden. AIMS: This review aimed to analyze the recommendations for managing severe P. falciparum malaria in different World Health Organization (WHO) malaria-endemic regions and considered their adherence to WHO guidelines. MATERIALS AND METHODS: Countries with the highest number of indigenous P. falciparum malaria cases from four WHO regions were identified, and malaria treatment guidelines were searched using databases. RESULTS: Intravenous administration of artesunate is the mainstay of treatment for severe P. falciparum malaria. Most guidelines lack a mechanism for referring patients with severe malaria, between different levels of health facilities, and lack specific criteria for intensive care unit admission. CONCLUSIONS: Mefloquine, artemisinin, combination products containing mefloquine, should be used with caution in cerebral malaria because of neuropsychiatric and cognitive complications. Understanding how guidelines and recommendations for the clinical management of malaria are adopted in different epidemiological settings will help contextualize the value and validity of recommendations for the treatment of severe malaria.