Appendix 5 – Canadian Malaria Network: Canadian recommendations for the prevention and treatment of malaria

An Advisory Committee Statement (ACS) from the
Committee to Advise on Tropical Medicine and Travel (CATMAT)

Preamble

The Committee to Advise on Tropical Medicine and Travel (CATMAT) provides the Public Health Agency of Canada (PHAC) with ongoing and timely medical, scientific, and public health advice relating to tropical infectious disease and health risks associated with international travel. PHAC acknowledges that the advice and recommendations set out in this statement are based upon the best current available scientific knowledge and medical practices, and is disseminating this document for information purposes to both travellers and the medical community caring for travellers.

Persons administering or using drugs, vaccines, or other products should also be aware of the contents of the product monograph(s) or other similarly approved standards or instructions for use. Recommendations for use and other information set out herein may differ from that set out in the product monograph(s) or other similarly approved standards or instructions for use by the licensed manufacturer(s). Manufacturers have sought approval and provided evidence as to the safety and efficacy of their products only when used in accordance with the product monographs or other similarly approved standards or instructions for use.

Appendix V: Canadian malaria network —Accessing parenteral artesunate or quinine

The Canadian Malaria Network (CMN), in collaboration with Health Canada’s Special Access Programme and the Public Health Agency of Canada, keeps supplies of intravenous artesunate and quinine at major medical centres across the country for rapid access to effective treatment for severe malaria. These life-saving drugs are available 24 hours per day by contacting the pharmacies listed on the CMN webpage. These drugs are not licenced in Canada and are only available through the CMN, and require treating physicians to report on the use of these drugs (see below).

Severe malaria is not common in Canada, with 195 cases treated through the CMN between August 2001 and August 2012. The number of cases per year has increased from 7 cases in 2002 to 30 in 2010 and cases have been spread across the country. This means that these scarce drugs must be strategically distributed across the country (see Chapter 7 for information on management of malaria).

Each of the participating CMN centres has on-site a designated physician with experience in treating malaria. For after-hours assistance, please contact the infectious disease consultant on call at the closest centre.

Each treatment dose comes with dispensing information and two surveillance forms (Form A and Form B). The attending physician fills out Form A at the time of access to / request for intravenous artesunate or quinine and Form B at discharge / end of malaria therapy. This information is vital to inform policy for distribution of these drugs. In addition, the organizations that supply these drugs need to be notified of any drug-related adverse events.

Table V.1: Criteria for severe falciparum malariaTable V.1 note *
Clinical manifestation Laboratory test
Prostration/impaired consciousness Severe anemia (hematocrit < 15%; Hb ≤ 50 g/L)
Respiratory distress Hypoglycemia (blood glucose < 2.2 mmol/L)
Multiple convulsions Acidosis (arterial pH < 7.25 or bicarbonate < 15 mmol/L)
Circulatory collapse Renal impairment (creatinine > 265 µmol/L)
Pulmonary edema (radiological) Hyperlactatemia
Abnormal bleeding Hyperparasitemia (≥ 2%)
Jaundice
Hemoglobinuria

Adapted from: Guidelines for tåhe treatment of malaria, World Health Organization, 2010.

Table V.1 note *

In patients with Plasmodium falciparum asexual parasitemia and no other obvious cause of symptoms, the presence of one or more of the clinical manifestations or laboratory features shown in Table V.1 classifies the patient as having severe malaria. Please note for those individuals who do not meet criteria for severe malaria, but require parenteral therapy, due to inability to tolerate oral treatment, IV quinine should be used. Artesunate is in short supply and should be reserved for those with severe malaria.

Return to Table V.1 note * referrer

To obtain parenteral artesunate or quinine, please contact the pharmacy in your area listed on the CMN webpage.

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