Management of severe paediatric malaria in resource-limited settings

BMC Medicine

Kathryn Maitland¹ 

[1]Wellcome Trust Centre for Clinical Tropical Medicine, and Department of Paediatrics, Faculty of Medicine, Imperial College, London, UK

关键词: Supportive Care;    Bacterial Infection;    Treatment;    Clinical Trial;    Mortality;    Children;    Africa;    Malaria;   

Others  :  1134632
DOI  :  10.1186/s12916-014-0263-6

 received in 2014-10-07, accepted in 2014-12-18,  发布年份 2015

【 摘 要 】

Over 90% of the world’s severe and fatal Plasmodium falciparum malaria is estimated to affect young children in sub-Sahara Africa, where it remains a common cause of hospital admission and inpatient mortality. Few children will ever be managed on high dependency or intensive care units and, therefore, rely on simple supportive treatments and parenteral anti-malarials. There has been some progress on defining best practice for antimalarial treatment with the publication of the AQUAMAT trial in 2010, involving 5,425 children at 11 centres across 9 African countries, showing that in artesunate-treated children, the relative risk of death was 22.5% (95% confidence interval (CI) 8.1 to 36.9) lower than in those receiving quinine. Human trials of supportive therapies carried out on the basis of pathophysiology studies, have so far made little progress on reducing mortality; despite appearing to reduce morbidity endpoints, more often than not they have led to an excess of adverse outcomes. This review highlights the spectrum of complications in African children with severe malaria, the therapeutic challenges of managing these in resource-poor settings and examines in-depth the results from clinical trials with a view to identifying the treatment priorities and a future research agenda.

【 授权许可】

   
2015 Maitland; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

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