Clinical Updates
26 January 2007
UK malaria treatment guidelines published
The Health Protection Agency (HPA) Advisory Committee on Malaria Prevention (ACMP) has written new guidelines on the diagnosis and treatment of malaria in the United Kingdom (UK) [1]. These guidelines are an essential resource for all healthcare professionals involved in the diagnosis and treatment of tropical disease. They define best practice in UK health settings where rapid diagnosis, safe medicines and high-quality medical care are readily available.
The aim of the guidelines is to improve the timeliness and safety of malaria treatment in the UK, especially in areas where relatively few cases are seen.
Malaria is not endemic in the UK, but 1,500 to 2,000 imported cases are reported annually to the HPA, with 11 deaths recorded in 2005 [2]. Despite a low case fatality rate in the UK, malaria is not a trivial disease. Uncomplicated malaria can require up to 10 days of treatment, whilst severe malaria can result in prolonged intensive care admission and has a 10% to 15% fatality rate [3, 4].
The new guidelines are designed to be used in conjunction with the treatment algorithm which the ACMP developed with the British Infection Society [5].
Advice for Travellers
Nearly all malaria cases are preventable if travellers are aware of the risk of malaria, follow mosquito bite avoidance measures, and comply with malaria prevention tablets before, during and after travel [6]. Travellers should promptly seek medical care for a febrile illness that occurs in the several weeks after return (up to a year). Health professionals should always consider the possibility of malaria in feverish or seriously ill patients with a history of travel to endemic areas [1].
The guidelines can be found on the HPA website at:
http://www.hpa.org.uk/infections/topics_az/malaria/
References
1. Lalloo DG, Shingadia D, Pasvol G, et al. UK malaria treatment guidelines. J Infect 2007;54:111-21.Available online at: http://www.hpa.org.uk/infections/topics_az/malaria/pdf/
2. HPA. Malaria imported into the United Kingdom in 2005: implications for those advising travellers. Commun Dis Rep CDR [serial online] 2006 [accessed 26 January 2007];16(23):News. Available at: http://www.hpa.org.uk/cdr/archives/2006/cdr2306.pdf
3. Leder K, Black J, O’Brien D et al. Malaria in travellers a review of the GeoSentinel surveillance network. Clin Infect Dis 2004; 39:1104 -12
4. Mishra S K, Mohanty S, Mohanty A et al. management of severe and complicated malaria. J Postgrad Med 2006;4:281-7.
5. The British Infection Society. Algorithm for the initial assessment and management of malaria in adults. Available online at:
http://www.britishinfectionsociety.org/documents/
6. Chiodini P, Hill D, Lalloo D, et al. Guidelines for malaria prevention in travellers from the United Kingdom. 2007, London: Health Protection Agency. 106. Available at: http://www.hpa.org.uk/infections/topics_az/malaria/
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