Canadian-Malaria-Network

Canadian Malaria Network

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Streamlined Medical Access to Artesunate or Quinine for Severe Malaria Treatment

TO OBTAIN PARENTERAL THERAPY:

Click the ‘CMN Pharmacy & Physician Contact List’ below and find a distributing CMN site near you

CMN Pharmacy & Physician Contact List | Liste de contacts des pharmacies et médecins du RCP
Form A (English) | Formulaire A (français)
Form B (English) | Formulaire B (français)
Suspected Adverse Reaction Report (English) | DĂ©claration d’effets indĂ©sirables prĂ©sumĂ©s (français)

The Canadian Malaria Network (CMN) is established in 13 medical centres across Canada and maintains and facilitates rapid access to strategically-located supplies of intravenous artesunate and quinine for the treatment of severe malaria.

Malaria

Malaria continues to be a major cause of death worldwide and is the principal life-threatening infection facing Canadian travellers in malaria-endemic areas. Severe P. falciparum malaria infections may have a mortality rate of 20% or higher. Patients require immediate hospitalization and urgent, intensive medical management, including parenteral malaria therapy. Severe malaria is not a common disease in Canada, with an average of 14 cases per year (range 8-20 cases annually from 2001-2008)*. However, these cases are dispersed across the country, and attest to the need for distribution of these scarce antimalarial drugs for treatment of severe malaria across the country.

*Note: Fever occurring in a traveller within three months of returning from a malaria-endemic area is a medical emergency and should be investigated urgently with thick and thin blood films for malaria.

Criteria for Severe Falciparum Malaria

EITHER

History of recent possible exposure and no other related pathology

OR

Asexual forms of Plasmodium falciparum on blood smear

AND

Any one or more of the following 15 features:

  1. Hyperparasitemia (>2% in non-immune, >5% in semi-immune)
  2. Impaired consciousness or coma
  3. Prostration (unable to walk or sit up without assistance)
  4. Multiple convulsions (>2 in 24hrs)
  5. Respiratory distress (acidotic breathing)
  6. Respiratory failure / Pulmonary edema / ARDS
  7. Circulatory collapse / shock (SBP<80mmHg adults and <50mmHg children)
  8. Acute kidney injury / renal failure (Cr >265”mol/L or >upper limit for age for children)
  9. Jaundice (Total bilirubin >45”mol/L)
  10. Abnormal spontaneous bleeding/DIC
  11. Hypoglycemia (<2.2mmol/L)
  12. Metabolic Acidosis / Acidemia (pH<7.25, HCO3<15mmol/L)
  13. Severe anemia (< 50g/L, in children; <70g/dL, in adults)
  14. Hemoglobinuria (macroscopic)
  15. Hyperlactataemia (lactate >5mmol/L)

 Adapted from: Management of Severe Malaria – A Practical Handbook, 3rd edition, World Health Organization, 2013, Geneva.

Malaria Treatment

Artesunate is the preferred medication for the treatment of severe and cerebral malaria due to P. falciparum*. Quinine is a possible alternative when artesunate is contraindicated. Both drugs are made available in Canada via the CMN through Health Canada’s Special Access Program, a program that allows practitioners to request access to drugs that are unavailable for sale in Canada. Although quinidine is available and is equally efficacious in treating malaria, it has a risk of life-threatening cardiotoxicity and an associated requirement for cardiac monitoring.

*NOTE: If the only indication for the use of parenteral therapy is that the patient is unable to tolerate oral therapy (NOT severe malaria), then quinine is the treatment of choice – without a loading dose.

Access to Drugs through the Network

To obtain parenteral artesunate or quinine, please contact the nearest pharmacy in the attached CMN Pharmacy & Physician Contact List. Service is available 24 hours per day. The designated physician for each Center can be used as a resource for any questions you may have with regard to the treatment of malaria. After-hours assistance can be obtained by contacting the infectious disease consultant on call at the respective center.

Once a request is made to any of the designated CMN centres for either parenteral artesunate or quinine, the attending physician will receive the following via courier delivery:

  • Treatment dose
  • Information on treatment and chemotherapy for severe falciparum malaria
  • Forms to be completed for the collection of surveillance data (Forms A & B).

Prescribing physicians have obligations to report severe adverse events immediately to the Canadian Malaria Network and to Health Canada. Physicians must also provide information about the patient and drug usage through the completion of Form A (link to download below) within 24 hours of first drug dosage, and Form B (link to download below) on day 7. The forms should be sent to the CMN National Coordinating Centre Office by email or fax.

Canadian Malaria Network National Coordinating Centre

Division of Infectious Diseases, The Ottawa Hospital

Phone: 613-737-8184, Fax: 613-737-8164

Email: CanadianMalariaNetwork@toh.on.ca

Official Website: http://www.phac-aspc.gc.ca/tmp-pmv/quinine/

Resources and Links

Canadian recommendations for the prevention and treatment of malaria, 2014.

Management of severe malaria – A practical handbook. Third edition (2013)

World Health Organization Guidelines for the treatment of malaria, Second edition. 2010.

CanTravNet : the Canadian Travel Medicine Network.

GeoSentienel Global Surveillance Network

 

TO OBTAIN PARENTERAL THERAPY: 

Click the ‘CMN Pharmacy & Physician Contact List’ below and find a distributing CMN site near you

CMN Pharmacy & Physician Contact List | Liste de contacts des pharmacies et médecins du RCP
Form A (English) | Formulaire A (français)
Form B (English) | Formulaire B (français)
Suspected Adverse Reaction Report (English) | DĂ©claration d’effets indĂ©sirables prĂ©sumĂ©s (français)