23 January 2006

Emergency treatment of malaria in travellers

The World Health Organization (WHO) has released new guidelines for the treatment of malaria [1]. Artemisinin-based combination treatments (ACTs) are recommended for treatment for Plasmodium falciparum malaria because of their high efficacy. Due to concern that resistance to artemisinins will develop if they are used as monotherapy, WHO has called for artemisinins to always be produced in combination with another agent. 

The importance of treatment of malaria in resource-poor regions of the world raises the issue of treatment of malaria in travellers that may occur during their trip.

Prior to their trip, travellers are advised to seek medical advice to determine if there is a risk of malaria. The UK malaria guidelines give clear guidance on this [2]. To prevent malaria travellers should:

• exercise mosquito bite avoidance
• select and comply with an appropriate antimalarial drug
• be aware of the signs and symptoms of malaria

In order to deal with the low risk of acquiring malaria during travel:

• Travellers who develop a febrile illness (≥ 38 C) seven or more days after being in a malaria-risk region, should seek prompt, reliable medical care. Symptoms usually associated with malaria are fever, myalgia and headache, but also may include diarrhoea and cough.
• Travellers to remote areas who are not able to obtain medical care promptly (within 24 hours) can consider carrying a stand-by, self-treatment dose of an antimalarial.
• The standby option should be carefully discussed before travel with clear written instructions given.
• Malaria medications obtained over-the-counter in resource poor regions may not be effective due to counterfeit or sub-standard production.  Therefore travellers who may need self-treatment should source medication in the UK prior to departure.

Recommended standby regimens are described in detail in the UK malaria guidelines [2]. The drug that is chosen should ideally be different than that which is being taken for chemoprophylaxis. The following drug combinations are currently recommended:

• Atovaquone/proguanil (Malarone®)
• Co-artemether (artemether/lumefantrine; Riamet®)
• Quinine plus doxycycline

All those who start emergency self-treatment should continue to seek medical care and be evaluated as soon as possible.

References

1. World Health Organization. WHO calls for an immediate halt to provision of single-drug artemisinin malaria pills. 19 January 2006. [cited 20 January 2006] Available at: http://www.who.int/mediacentre/news/releases/2006/pr02/en/ind

ex.html

2. Bradley DJ, Bannister B. Guidelines for malaria prevention in travellers from the United Kingdom for 2003. Commun Dis Public Health 2003;6:180-99. Available at: http://www.hpa.org.uk/cdph/issues/CDPHvol6/No3/6(3)p180-99.pdf

Links

NaTHNaC malaria information sheet: http://www.NaTHNaC.org/pro/factsheets/malaria.htm

NaTHNaC malaria chemoprophylaxis information sheet : http://www.NaTHNaC.org/pro/factsheets/malariaproph.htm

Hughes C, Tucker R, Bannister B and Bradley DJ. Malaria prophylaxis for long-term travellers. Commun Dis Public Health 2003;6:200-8: www.hpa.org.uk/cdph/issues/CDPHvol6/No3/6(3)p200-208.pdf

Health Protection Agency, Advisory Committee on Malaria Prevention: http://www.hpa.org.uk/infections/topics_az/malaria/ACMP.htm