Posted by: imasajanote | April 20, 2010

About TB

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9 MARCH 2010 | GENEVA —

The World Health Organization (WHO) is releasing new guidelines for the treatment of malaria, and the first ever guidance on procuring safe and efficacious anti-malarial medicines.

In recent years a new type of treatment called artemisinin-based combination therapy (ACTs) has transformed the treatment of malaria, but if not used properly the medicine could become ineffective.

Guidelines emphasize testing

The Guidelines for the Treatment of Malaria (second edition) provide evidence-based and current recommendations for countries on malaria diagnosis and treatment. The main changes from the first edition of the guidelines (published in 2006) are the emphasis on testing before treating and the addition of a new ACT to the list of recommended treatments.

Related link

Guidelines for the treatment of malaria: second edition

Good procurement practices for artemisinin-based antimalarial medicines

Read more about malaria

“The world now has the means to rapidly diagnose malaria and treat it effectively” said Dr Robert Newman, Director of the WHO Global Malaria Programme (GMP). “WHO now recommends diagnostic testing in all cases of suspected malaria. Treatment based on clinical symptoms alone should be reserved for settings where diagnostic tests are not available,” he added.

In 2008, just 22% of suspected malaria cases were tested in 18 of 35 African countries reporting. Until now, most clinics had to rely on microscopy, but the recent development of quality-assured Rapid Diagnostic Tests (RDTs) using a dip stick and a drop of blood means a policy change is possible. The tests can reliably demonstrate the presence or absence of malaria parasites in the blood and can be performed at all levels of the health system, including community settings.

Universal diagnostic testing

The move towards universal diagnostic testing of malaria is a critical step forward in the fight against malaria as it will allow for the targeted use of ACTs for those who actually have malaria. The aim is to reduce the emergence and spread of drug resistance and to help identify patients who have fever, but do not have malaria, so that alternative diagnoses can be made and appropriate treatment provided. Therefore, better management of malaria has a positive impact on management of other childhood illness and overall child survival.

WHO is supporting malaria endemic countries to improve the quality of their diagnostic services using both microscopy and RDTs, and urging the manufacturers of RDTs to continue improving the accuracy and quality of these critically important diagnostic tests.

WHO estimates that 80 countries have adopted ACTs for first-line treatment of uncomplicated P. falciparum malaria. In the guidelines, WHO emphasizes the importance of treating this deadliest form of the disease with artemisinin-based combination therapies. WHO has now added a fifth ACT – dihydroartemisinin plus piperaquine – to the previous list of recommended medicines.

Preventing drug resistance

WHO recommends oral artemisinin-based monotherapy should be removed from the market because their use will hasten the development of parasite resistance. Countries need to ensure that patients are diagnosed properly and take the full dose of ACTs to prevent the development of drug resistance.

Procurement quality

The first ever guidelines on Good procurement practices for artemisinin-based antimalarial medicines are based on the newest stringent internationally agreed production and procurement quality standards. This manual aims to improve the capacities of national and international procurement officers in the understanding of key quality elements and required documentation. The content is presented as a practical and concise 16-step practical checklist to guide the selection and procurement of safe and effective medicines meeting international quality standards.

“Pharmaceutical markets in malaria endemic countries are often unregulated and national authorities need practical help to assess the quality of malaria medicines before they buy them” says Dr Andrea Bosman, Coordinator of the Medicines and Diagnostics Unit at GMP. “Procurement channels are highly fragmented and so there are too many antimalarials of varying quality on the market.”

Poor-quality medicines affect the health and lives of patients, damage the credibility of health services and, by generating sub-therapeutic drug levels in malaria patients, help develop resistance to this important life-saving class of pharmaceuticals.

“These guidelines will help countries select and procure effective medicines of good quality and save lives by improving the way patients are diagnosed and treated,” says Dr George Ki-Zerbo, Malaria Programme Manager at the WHO Regional Office for Africa in Brazzaville.

Half of the world’s population is at risk from malaria. Each year almost 250 million cases occur, causing 860 000 deaths. Approximately 85% of these deaths are among children, and most occur in Africa.

Posted by: imasajanote | April 18, 2010

Obat malaria terbaru

Artemether for severe malaria

Clinical bottom line: Artemether was equally as effective as quinine in the treatment of severe malaria; mortality rates were about 15%.

Artemether is the active component of the Chinese herb qinghao (Artemesia annua). Extracts of qinghao have been used in traditional Chinese herbal medicine to treat febrile illness. Uncontrolled studies have shown artemether to be effective for treating malaria.

Systematic review:

Pittler MH, Ernst E. Artemether for severe malaria: A meta-analysis of randomised clinical trials. Chronic Infectious Disease 1999; 28: 597-601.

Date review completed: January 1998

Number of trials included: Nine

Number of patients: (915 artemether; 904 quinine)

Control groups: quinine.

Main outcomes: mortality rate.

Inclusion criteria were randomised, comparative trial which assessed artemether and quinine for the treatment of severe malaria.

Medline, Embase, Biosis, CICSOM and the Cochrane Library were searched (to January 1998) for published reports. The reviewers’ own files were searched for relevant studies. Bibliographies of retrieved trials and reviews were checked for additional citations and no language restrictions were made. Manufacturers of artemether and experts were contacted for published and unpublished trials. Data were extracted in a standardised, predefined manner by the two reviewers. Methodological quality was rated using a validated 5-point scale. A meta-analysis was conducted; mortality rate and odds ratios (with 95% confidence intervals) were calculated using a random effects model.


Nine studies were included; all used the WHO definition of severe malaria. One study was double blind, the others were open. Various doses of intravenous or intramuscular artemether or quinine were assessed (Table 1).

Table 1

Dose Intramuscular Intravenous
Loading dose 3.2, 4 or 160 mg/Kg 20 mg/Kg
Followed by either: 2 mg/Kg every eight hours until the patient could drink 10 mg/Kg every eight hours until parasitemia was cleared
1.6 mg/Kg/day until parasitemia was cleared or for 3-4 days 10 mg/Kg every eight hours until arousal
80 mg/day for six days 10 mg/Kg every eight hours for 3 or 7 days

The results of the individual studies are shown in Figure 1.

Data from all nine studies were pooled in a meta-analysis. The pooled mortality rate was 15% (95% C.I. 12 to 17; 134/915 patients) with artemether and 18% (15 to 20; 159/904 patients) with quinine.

For cerebral malaria, the mortality rate was 19% (15 to 23) with both treatments (83/437 patients with artemether and 81/432 patients with quinine); odds ratio 0.76 (0.5 to 1.1).

For mixed malaria, the mortality rate was 11% (8 to 13) with artemether (51/478 patients) and 17% (13 to 20; 78/472 patients) with quinine. There was no significant difference between artemether and quinine for any analysis.

Adverse effects

Hypoglycemia, abdominal pain and pain at the injection site were reported with artemether. The reviewer’s stated that adverse effects occurred less frequently with artemether than with quinine and were milder.


The lack of blinding in these studies is unlikely to be important because bias should not influence mortality. Patients were randomised to treatment groups, so selection bias should be minimised. The limitation of the meta-analysis is that the results were based on relatively small numbers of patients. The mortality rates reported with artemether were comparable to those reported with quinine. This suggests that artemether may provide a useful alternative for treating severe malaria in areas where resistance to quinine is a problem.

Duocotexcin Obat Malaria Terbaru

November 7, 2007

Malaria adalah penyakit yang menyebalkan. Malaria menjadi penyakit yang khas untuk Papua. Untuk orang yang pertama kalinya menginjakkan kakinya di Papua dan berniat berdomisili untuk waktu yang lama, hati-hati dan bersiaplah kena malaria.

Saking dahsyatnya malaria, saat ini ada tiga jenis obat penyakit malaria, yaitu cloroquin, piremetamin dan sulvadoxin,  sudah tidak mempan lagi untuk mengobati pasien malaria di Timika, Papua.

Tapi tidak perlu khawatir, ada obat malaria terbaru yang sangat ampuh untuk mengobati malaria yaitu Duocotexcin, obat ini mengandung dihidroartemisinin yang berfungsi untuk membunuh kuman dengan sangat cepat sedangkan piperquin akan lebih lama bertahan dalam darah untuk menjaga agar tidak terjadi infeksi berulang.

Sejauh ini obat duocotexcin belum didistribusikan ke seluruh Puskesmas dan klinik-klinik kesehatan di seluruh Mimika, hanya terdapat di Rumah Sakit Mitra Masyarakat, Klinik PHMC, RS Tembagapura, RS Waa-Banti, Klinik ISOS, Puskemas Mapurujaya, Puskesmas Timika Jaya/SP 2, Puskesmas Kwamki Lama dan Puskesmas Kwamki Baru.

Jadi Kalau terserang malaria, silakan tes malaria di klinik jika positif malaria, bawalah hasil tes tersebut ke tempat-tempat tersebut untuk mendapatkan duocotexin. Efek samping obat ini paling banyak ditemui mencret.

Arterakine, obat malaria pengganti Duo-Cotexcin

September 23, 2009

Berabad-abad  yang lalu, saya pernah menulis mengenai obat malaria terbaru yang namanya Duo-Cotexcin. Banyak pertanyaan baik yang di tulis di kolom komentar maupun via email.

Pertanyaan-pertanyaan tersebut diantaranya : Duo-Cotexcin dapat di beli dimana? apakah obat ini bisa menyembuhkan malaria?

Duo-Cotexcin hanya tersedia di puskesmas maupun rumah sakit di Timika, Kabupaten Mimika yaitu Rumah Sakit Mitra Masyarakat (RSMM), Puskesmas Timika, Puskesmas SP 2, RS Waa-Banti dan Puskesmas Kwamki Lama (kalo nga salah ).

Duo Cotexcin tidak diperjualbelikan karena masih dibawah penelitian, dan saat ini Duo Cetexcin sudah tidak ada lagi sebagai gantinya yaitu ARTERAKINE. Bahan Obat dan khasiatnya sama, hanya beda nama dagangnya saja dan tersedia di tempat-tempat yg sudah saya sebutkan tadi.

Dua minggu lalu saya terserang malaria Tropika plus 4 dan istri plus 2.  Kami berobat di RSMM dan diberi ARTERAKINE dengan dosis 4 x 1 selama 3 hari ditambah pil primaquin 3 butir minum pagi hari. Menurut kawan saya yang seorang peneliti malaria dosis obat tersebut tergantung berat badan pasien.

Tiga hari kemudian setelah minum ARTERAKINE, malaria langsung lewat. Obat ini dapat menyembuhkan Malaria Tropika maupun Tertiana.

CATATAN: ARTERAKINE hanya ada di puskesmas dan RS tertentu dan belum di jual bebas.

Posted by: imasajanote | April 18, 2010

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