RESUMO
En este informe el Grupo Científico de la OMS sobre Quimioterapia del Paludismo ha intentado no sólo formular recomendaciones acerca del empleo de fármacos específicos sino también proporcionar la información técnica requerida para evaluar y, si es necesario, adaptar esas recomendaciones. En consecuencia, en el informe se analizan los factores que es preciso considerar al formular y poner en práctica una política sobre el empleo de fármacos para combatir el paludismo. Se examina en detalle el tratamiento de los casos tanto graves como no complicados de la enfermedad y se abordan aspectos más generales, como la estimación de las cantidades necesarias de medicamentos, su adquisición y los sistemas de vigilancia. Hay una sección especial que versa sobre los fármacos antipalúdicos actualmente sometidos a estudio. El informe está dirigido básicamente a los planificadores y administradores de nivel medio responsables de los servicios de salud, pero los investigadores, los clínicos y los planificadores de la atención primaria de salud también encontrarán en él orientación útil acerca de los factores que influyen en la selección de medicamentos para tratar el paludismo
Assuntos
Antimaláricos , MaláriaRESUMO
A practical guide to the selection and administration of drugs for the management of both uncomplicated malaria, including illness caused by Plasmodium vivax, and severe malaria caused by Plasmodium falciparum. As the immense complexity of malaria prohibits the development of universal guidelines for treatment or control, the book covers the principles governing the choice of drugs in great detail, so that recommendations can be adapted to the local malaria situation. Throughout, readers are reminded of the complexities of malaria control and cautioned against underestimation or superficial interpretation of the problem. Emphasis is placed on the importance of clinical diagnosis and management as the only available approach to the malaria problem in many parts of the world. The book opens with a review of factors that need to be considered in developing and implementing a policy on the use of drugs in malaria. Current practices in the assessment of symptoms and diagnosis of disease are briefly reviewed in the second chapter, which includes advice on microscopical examination and a discussion of risks associated with the taking of blood for smears or sampling. The most extensive part provides a highly detailed guide to the management and treatment of different forms of malaria. Uncomplicated malaria is covered first, with each of the currently used antimalarials profiled in terms of efficacy, dosage, indications, toxicity, side effects, and dangerous drug interactions. The chapter on severe falciparum malaria presents information that can help clinicians recognize severe disease, select an appropriate therapeutic drug, manage an emergency, avoid potentially fatal practices, and treat complications. Tables are used to summarize recommended therapeutic measures for chloroquine-sensitive and chloroquine-resistant falciparum malaria that should be followed at the peripheral or community level, the intermediate level, and the highest level of the health service. Subsequent chapters discuss the increasing difficulty of chemoprophylaxis, noting that serious adverse reactions to several important prophylactic drugs have been documented in the last few years, and offer advice on estimating the amount of antimalarial drugs necessary, their procurements, pricing policies, and systems for monitoring drug efficacy and adverse reactions. A concluding chapter evaluates eleven new antimalarial drugs, including artemisinin and its derivatives used in China
Assuntos
Malária , AntimaláricosRESUMO
Ce rapport constitue un guide pratique pour la sélection et l'administration des médicaments utilisés dans la prise en charge des cas de paludisme sans complications, provoqués notamment par Plasmodium vivax, et des cas graves provoqués par Plasmodium falciparum. Infiniment complexe, le paludisme ne se prête pas à l'établissement d'un cadre universel pour le traitement ou la lutte. C'est pourquoi le rapport présente les principes régissant le choix des médicaments de façon très détaillée ce qui permet d'adapter les recommandations à la situation locale. La complexité de la lutte antipaludique et le risque de sous-estimer ou d'interpréter le problème de façon superficielle sont constamment rappelés. L'accent est mis sur l'importance du diagnostic et de la prise en charge clinique des cas comme seul moyen dont on dispose pour faire face au problème dans bien des parties du monde. Un chapitre particulièrement intéressant évalue 11 nouveaux antipaludéens notamment l'artémisinine et ses dérivés qui sont utilisés en Chine
Assuntos
Malária , AntimaláricosRESUMO
The development of common guidelines on the use of antimalarial drugs is made particularly difficult by the rapidly changing epidemiological patterns of malaria, and their variability even within a country. Recognizing this, the WHO Scientific Group on the Chemotherapy of Malaria, in the present report has attempted no only to make recommendations for the use of specific drugs, but also to provide the technical information needed to evaluate and, if necessary, adapt those recommendations. The report therefore discusses the factors that need to be considered in developing and implementing a policy on the use of drugs in malaria. The management and treatment of both severe and uncomplicated malaria are dealt with in detail, and more general topics, such as estimating the amounts of drugs needed, their procurement, and monitoring systems, are also considered. A separate section deals with antimalarial drugs currently under development. The report is addressed primarily to middle-level planner and administrators responsible for malaria services, but research workers, clinicians and primary health planners wil also find a useful guide to the factor that
Assuntos
Malária/tratamento farmacológico , Antimaláricos/terapiaRESUMO
Rapport sur l'état des connaissances concernant l'emploi des antipaludiques et examen des progrès récents de la recherche chimiothérapeutique. L'attention porte en particulier sur les problèmes, dans les domaines de la recherche et de la chimiothérapie, dus à l'apparition d'une pharmacorésistance chez les plasmodies pathogènes de l'homme. Les différents sujets traités sont les suivants : mécanismes de la pharmacorésistance chez les plasmodies ; distribution géographique ; fréquence et intensité de la pharmacorésistance chez les parasites du paludisme ; méthodes in vivo et in vitro d'évaluation de la sensibilité aux médicaments ; surveillance de la réponse aux antipaludiques ; critères d'évaluation de la pharmacorésistance et mesures destinées à empêcher ou à limiter l'apparition et l'extension de la pharmacorésistance
