Management of severe paediatric malaria in resource-limited settings. Maitland K. 2015.
Management of severe paediatric malaria in resource-limited settings [link]Paper  abstract   bibtex   
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. Copyright © 2015 Maitland, licensee BioMed Central.
@misc{maitland_k._management_2015,
	title = {Management of severe paediatric malaria in resource-limited settings},
	url = {http://www.biomedcentral.com/bmcmed/},
	abstract = {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. Copyright © 2015 Maitland, licensee BioMed Central.},
	journal = {BMC Medicine},
	author = {{Maitland K.}},
	year = {2015},
	keywords = {*Africa, *bacterial infection, *child, *clinical trial, *human, *malaria, *malaria/di [Diagnosis], *malaria/dt [Drug Therapy], *malaria/ep [Epidemiology], *malaria/et [Etiology], *malaria/pc [Prevention], *mortality, Africa, African, Child, Plasmodium falciparum, adrenalin, adult, adverse outcome, anemia, antimalarial agent, antimalarial agent/cm [Drug Comparison], antimalarial agent/dt [Drug Therapy], artesunate, artesunate/dt [Drug Therapy], artesunate/pa [Parenteral Drug Administration], blood transfusion, brain edema/dt [Drug Therapy], brain malaria/di [Diagnosis], brain malaria/dt [Drug Therapy], brain malaria/et [Etiology], clinical examination, clinical feature, clinical trial (topic), confidence interval, continuous infusion, death, deferiprone/dt [Drug Therapy], deferoxamine/cm [Drug Comparison], deferoxamine/dt [Drug Therapy], deferoxamine/iv [Intravenous Drug Administration], dexamethasone/ae [Adverse Drug Reaction], dexamethasone/dt [Drug Therapy], disease course, disease severity, fluid resuscitation, gastrointestinal hemorrhage/si [Side Effect], hemoglobinuria, hospital admission, hospital patient, human, hypoglycemia, incidence, intensive care unit, iron chelation, levamisole/dt [Drug Therapy], levamisole/po [Oral Drug Administration], major clinical study, malaria control, malaria falciparum, malaria falciparum/dt [Drug Therapy], malaria/dt [Drug Therapy], mefloquine/dt [Drug Therapy], metabolic acidosis, mixed infection, morbidity, mortality, neuroimaging, pathophysiology, pediatrics, pentoxifylline/dt [Drug Therapy], phenobarbital/cm [Drug Comparison], phenobarbital/dt [Drug Therapy], placebo, prognosis, quinine, quinine/cm [Drug Comparison], quinine/dt [Drug Therapy], respiratory distress, review, risk factor, steroid/dt [Drug Therapy], therapy}
}
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