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[Evaluation of imported pediatric malaria management in northern France]
L Elmansouf1, F Dubos, A Dauriac
1Unité de pédiatrie générale, urgences et maladies infectieuses, CHU de Lille, université Lille Nord-de-France, UDSL, 2, avenue Oscar-Lambret, 59000 Lille, France.
Insights
Pediatric malaria treatment in France showed poor adherence to guidelines, leading to therapeutic failures and increased healthcare costs. Optimizing management could significantly reduce hospital stays and expenses.
Area of Science:
- Infectious Diseases
- Pediatric Medicine
- Clinical Pharmacy
Context:
- Retrospective, multicentre cohort study in 18 French pediatric and infectious diseases units (2000-2006).
- Included 133 pediatric cases of imported malaria diagnosed via blood smear.
- Focused on treatment adequacy compared to established recommendations.
Purpose:
- To evaluate the adherence of pediatric malaria treatment to clinical recommendations.
- To identify the impact of treatment deviations on patient outcomes and healthcare costs.
Summary:
- Only 32% of pediatric malaria cases received treatment aligned with French Infectious Disease Society (SPILF) recommendations.
- Intravenous quinine and oral halofantrine were common first-line treatments, with no significant changes over the study period.
- Five therapeutic failures were documented, linked to suboptimal management.
Impact:
- Inadequate management resulted in treatment failures and increased hospital costs, estimated at 54,000 €.
- Optimal adherence to recommendations could have saved 117 hospital days.
- Highlights the need for improved implementation of malaria treatment guidelines in pediatric care.
Objectives:
The study's objective was to evaluate the adequacy of treatment to recommendations, for the management of pediatric malaria.
Methods:
A descriptive, retrospective, multicentre cohort study was conducted over a 7-year period (2000-2006) in 18 pediatric and infectious diseases units in northern France. All children, under 18 years of age, having consulted in one of these hospitals and for whom the diagnosis of malaria has been made by blood smear and/or thick drop examination, were included.
Results:
One hundred and thirty-three cases of imported malaria were reported. Among the 120 available files, 23 documented severe malaria. Treatment documentation was available for 115 patients. This treatment was initiated orally in 47 cases and intravenously in 68 cases. Intravenous quinine was the first-line treatment in 58% of cases. Halofantrine was the first-line oral treatment. No change was observed along the 6 years. Only 32% of management was in adequacy with recommendations. Five therapeutic failures were recorded. The optimal application of recommendations would have saved 117 days in terms of hospital stay, corresponding to 54,000 €.
Conclusions:
The French Infectious Disease Society (SPILF) recommendations were not well observed. This inappropriate management was responsible for treatment failures and increased costs.
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