A new debate in the open access journal PLoS Medicine questions whether all African children with fever should be treated presumptively with antimalarial drugs, or if treatment should wait until laboratory tests confirm malarial infection.
Blaise Genton and colleagues from Tanzania contend that declining malarial transmission rates in parts of sub-Saharan Africa and the availability of rapid diagnostic tests mean that it is time for the policy of presumptive treatment to change. That the proportion of fevers due to malaria has declined substantially, even in highly endemic areas, increases the relative likelihood of missing other potentially fatal diseases in children, argue the authors.
But Mike English and colleagues from Kenya disagree. They argue that there is not yet enough evidence to support abandoning presumptive treatment and that African health systems do not have the capacity to support a shift toward laboratory-confirmed rather than presumptive diagnosis and treatment of malaria in children under five. "If anxiety about drug costs (which are falling) and optimism that malaria is being defeated drive rapid policy change," the authors argue, "this may result in hurried policy doing more harm than good."
Citation: D'Acremont V, Lengeler C, Mshinda H, Mtasiwa D, Tanner M, et al. (2009) Time to move from presumptive malaria treatment to laboratory-confirmed diagnosis and treatment in African children with fever. PLoS Med 6(1): e252. doi:10.1371/journal.pmed.0050252
Citation: English M, Reyburn H, Goodman C, Snow RW (2009) Abandoning presumptive antimalarial treatment for febrile children aged less than five years—A case of running before we can walk? PLoS Med 6(1): e1000015. doi:10.1371/journal. pmed.1000015
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http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.1000015
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http://www.plos.org/press/plme-06-01-genton.pdf
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CONTACT:
Blaise Genton
Ifakara Health Research & Development Centre
Public Health and Epidemiology
Mikocheni
Dar Es Salaam, 78373
United Republic of Tanzania
+255 22 277 47 14 or +255 786 19 00 69
+255 22 277 47 14 (fax)
Blaise.Genton@unibas.ch
Mike English
KEMRI / Wellcome Trust / Oxford University
Child and Newborn Health
P.O. Box 43640
Nairobi, Nairobi 00100
Kenya
+2542-2710672
menglish@nairobi.kemri-wellcome.org
Journal
PLoS Medicine