Standby Emergency Treatment of Malaria in Travelers

Experience to Date and New Developments

Patricia Schlagenhauf; Eskild Petersen

Disclosures

Expert Rev Anti Infect Ther. 2012;10(5):537-546. 

In This Article

Expert Commentary & Five-Year View

Malaria prophylaxis to low-risk areas is a controversial subject. The use of SBET with mosquito bite prevention is an attractive, alternative strategy for travelers visiting areas where the risk of malaria infection is far lower than the risk of adverse events from drugs used for chemoprophylaxis. The widespread problem with substandard drugs in Asia and Africa means that travelers with prolonged stay in these areas should also be provided with SBET even if they are using drugs for chemoprophylaxis. 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.

Concise written guidelines with weight-based dosages should be provided to travelers carrying SBET. Combination malaria medications such as artemether/lumefantrine (Riamet) and dihydroartemisinin/piperaquine (Eurartesim) – now available in Europe – have good safety profiles, are effective against falciparum malaria and would appear to be the best options for SBET in areas with chloroquine resistance. More research is needed on their use in travelers. Other malaria treatments may be indicated for niche groups. Rapid malaria tests are evolving and improving and should be constantly reevaluated in the SBET context because the major pitfall of the strategy is the difficulty in diagnosing malaria, but, currently, rapid malaria tests are not routinely recommended for travelers.

More research is needed to define malaria risk at different destinations and to optimize strategies to protect heterogeneous groups of travelers against malaria.

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