Treatment Failure

Clinical description

Treatment failure is the persistence of signs and symptoms of malaria in a patient with a positive blood film for malaria parasites after three days of completing a recommended first-line treatment taken in full dosage. Treatment failure is not always due to drug resistance.

Treatment failure should be suspected if symptoms persist or the patient clinically deteriorates within 3 to 14 days for LA and 3 to 28 days for DP after initiation of drug therapy.

Causes of treatment failure may include:

• Unreported poor adherence to treatment
• Drug resistance
• Inadequate drug exposure due to: unrecognized incorrect dosage, vomiting within one hour of administration, unusual pharmacokinetic properties in an individual
• Misdiagnosis
• Counterfeit or defective drug
• Drug-drug interaction

Treatment

If after 14 or 28 days, adherence or dosage is found to have been incorrect, then 'treatment failure' is excluded and the primary treatment should be repeated correctly.

If however, treatment failure is confirmed, the patient should be treated with the second-line treatment (artesunate-amodiaquine), according to the recommended dosing schedule.