Standby emergency treatment of malaria in travelers: experience to date and new developments

Expert Rev Anti Infect Ther. 2012 May;10(5):537-46. doi: 10.1586/eri.12.42.

Abstract

The concept of 'standby emergency treatment' (SBET) describes the strategy where travelers carry an emergency malaria treatment for self-administration when no medical attention is available or for use under medical supervision after a confirmed malaria diagnosis, and raises many issues for discussion. International guidelines vary on the topic, and there is controversy regarding the appropriate niche for this imperfect strategy. There are situations when SBET can supplement chemoprophylaxis with mosquito bite prevention and for some travelers, particularly those visiting minimal malaria risk areas, carriage of SBET and concomitant anti-mosquito bite measures can constitute the main antimalaria strategy. A strong argument in support of equipping travelers with a quality effective antimalarial treatment as part of their travel medical kit is the global proliferation of counterfeit antimalarials, a situation that is increasing in Africa but is especially prevalent in Asia where more than 50% of artemisinin products are fake. New developments such as improved rapid malaria tests and their wider distribution together with the availability of effective, well-tolerated malaria treatments, such as atovaquone/proguanil, artemether/lumefantrine and a new artemisinin combination dihydroartemisin/piperaquine, which is licensed in Europe for uncomplicated malaria, suggest that it is time to revisit and re-evaluate this strategy for travelers.

MeSH terms

  • Antimalarials / administration & dosage*
  • Antimalarials / therapeutic use
  • Artemether, Lumefantrine Drug Combination
  • Artemisinins / pharmacology
  • Atovaquone / pharmacology
  • Chloroquine / pharmacology
  • Diagnostic Tests, Routine / standards
  • Drug Combinations
  • Emergency Treatment / methods*
  • Ethanolamines / pharmacology
  • Female
  • Fluorenes / pharmacology
  • Geography
  • Guidelines as Topic
  • Health Policy
  • Humans
  • Malaria / drug therapy*
  • Malaria / parasitology
  • Plasmodium / pathogenicity*
  • Pregnancy
  • Pregnancy Complications, Parasitic / drug therapy
  • Pregnancy Complications, Parasitic / parasitology
  • Proguanil / pharmacology
  • Sensitivity and Specificity
  • Travel
  • Travel Medicine / methods

Substances

  • Antimalarials
  • Artemether, Lumefantrine Drug Combination
  • Artemisinins
  • Drug Combinations
  • Ethanolamines
  • Fluorenes
  • atovaquone, proguanil drug combination
  • Chloroquine
  • Proguanil
  • Atovaquone