Standby Emergency Treatment of Malaria in Travelers

^†Data was taken from [18]. All other data was taken from [17].

Table 2.  Weight-based dosages ^† for standby emergency treatment in children and adults.

Chloroquine (100 mg base tablets)				Mefloquine (250 mg tablets)‡			Artemether/lumefantrine (20 mg/120 mg)				Atovaquone/proguanil§				DHA/PQP (note different tablet strengths)¶
Weight (kg)	Day 1	Day 2	Day 3	Weight (kg)	Day 1	Day 2#	Weight (kg)	Day 1	Day 2	Day 3	Weight (kg)	Day 1	Day 2	Day 3	Weight (kg)	Tablet strength	Dosing
5–6	½	½	½	5–6	¼	¼	5–14	1 + 1 after 8 h	1 + 1 after 12 h	1 + 1 after 12 h	5–8	2P	2P	2P	5–6	20 mg DHA/160 mg PQP	½ tablet daily for 3 days
7–10	1	1	½	7–8	½	¼					9–10	3P	3P	3P	7–12	20 mg DHA/160 mg PQP	1 tablet daily for 3 days
11–14	1½	1½	½	9–12	¾	½					11–20	1A	1A	1A	13–23	40 mg DHA/320 mg PQP	1 tablet daily for 3 days
15–18	2	2	½	13–16	1	½	15–24	2 + 2 after 8 h	2 + 2 after 12 h	2 + 2 after 12 h					24–35	40 mg DHA/320 mg PQP	2 tablets daily for 3 days
19–24	2½	2½	1	17–24	1½	1					21–30	2A	2A	2A
25–35	3½	3½	2	25–35	2	1½	25–34	3 + 3 after 8 h	3 + 3 after 12 h	3 + 3 after 12 h
36–50	4 + 1 after 6 h	5	2½	36–50	3	2	≥35	4 + 4 after 8 h	4 + 4 after 12 h	4 + 4 after 12 h	31–39	3A	3A	3A	>35	40 mg DHA/320 mg PQP	3 tablets daily for 3 days
>50	4 + 2 after 6 h	2	2	≥50	2 + 2	2					≥40	4A	4A	4A

^†Dosages given as number of tablets of the weight specified.
^‡Experience with mefloquine (Lariam®) in infants less than 3 months old or weighing less than 5 kg is limited.
^§Atovaquone/proguanil (Malarone®) should only be used in uncomplicated malaria, for example malaria in travelers from countries without malaria with a parasite count of less than 2% infected red blood cells or less than 5% in people from malaria-endemic countries.
^¶Take without food.
^#Day 2 in the context of mefloquine treatment means after 6–24 h.
A: Adult tablet; DHA: Dihydroartemisin; P: Pediatric tablet; PQP: Piperaquine.

^†Fansimef®.
CL: Chloroquine; H: Halofantrine; MQ: Mefloquine; PYR: Pyrimethamine; SDX: Sulphadoxine.

Authors and Disclosures

Patricia Schlagenhauf*¹ and Eskild Petersen<sup>2

1</sup>University of Zürich Centre for Travel Medicine, Institute for Social and Preventive Medicine, University of Zürich, Zürich, Switzerland.
²Department of Infectious Diseases, Aarhus University Hospital, Skejby, Aarhus, Denmark

Financial & competing interests disclosure
P Schlagenhauf has received research funding and/or speakers honoraria from F Hoffmann-La Roche, GlaxoSmithKline and Sigma-tau. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

*Author for correspondence
pat@ifspm.uzh.ch

Sidebar

Key Issues

• The carriage of standby emergency treatment (SBET) with mosquito bite prevention is an alternative strategy to chemoprophylaxis for travelers visiting areas where the risk of malaria infection is far lower than the risk of adverse events from drugs used 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.

• Combination malaria medications such as artemether/lumefantrine and dihydroartemisinin/piperaquine are fast-acting SBET options.

• Concise written guidelines with weight-based dosages should be provided to travelers carrying SBET.

• More data are needed on malaria risk at travel destinations and the use of protective strategies.