Management of Severe Plasmodium Falciparum Malaria in Adults. A Review of National and Regional Guidelines and their adherence to WHO guidelines

Abstract Background: the most prevalent and pathogenic malaria parasite associated with severe illness and death is Plasmodium falciparum. In non-endemic countries like the Russian federation, P. falciparum malaria is a relatively rare but potentially fatal disease found in travelers returning from countries with high malaria burden. Aims: this review aims to analyze the recommendations for managing severe Plasmodium falciparum malaria in different World Health Organization (WHO) malaria endemic regions and considered their adherence to the WHO guidelines. Materials and methods: we identified countries with the highest number of indigenous falciparum malaria cases from four WHO regions and search for their malaria treatment guidelines using databases. Results: intravenous artesunate is the mainstay treatment for severe falciparum malaria. Mefloquine or fansidar was not indicated in the reviewed guidelines as. Most guidelines lack a mechanism for referring patients with severe malaria, between different levels of health facilities and lack specific criteria for intensive care unit admission. Conclusions: mefloquine and artemisinin - combination products containing mefloquine should be used with caution in cerebral malaria due to neuropsychiatric and cognitive complications. Understanding how guidelines and recommendations for the clinical practice of malaria areadopted in different epidemiological settings will help to contextualize the value and validity of recommendations for treatment of severe malaria.