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

SBET: Local Guidelines & Legal Ramifications

There are several precautions needed when recommending SBET. The travelers should be properly informed about the symptoms of malaria and about the medication supplied for SBET, the probability that the febrile illness may not be malaria (common differential diagnoses are dengue fever, Salmonella typhi, influenza, chikungunya and others), common side effects and the use of the drug if vomiting occurs soon after intake. This information should be provided in writing so that the traveler has clear instructions if fever occurs.

Ideally, an SBET should be easily administered to ensure correct dosage and adherence. The SBET indication is rarely listed in the product specifications, and this has legal ramifications for prescribers in some countries.

Whether or not a drug is recommended for SBET is usually a matter for national guidelines. The WHO listing of possible SBET drugs are all malaria medications for use as treatments of 'uncomplicated malaria.' SBET as an indication is rarely listed in product specifications, but it can be argued that SBET use is incorporated in the indication of the treatment of uncomplicated malaria, and SBET is therefore not a new indication, merely a mode of administration agreed on between the traveler and the healthcare provider and for use under medical supervision if at all possible.

A major challenge with recommending SBET is to provide adequate written guidelines to the traveler stressing the importance of medical consultation at the first sign of fever, the circumstances that indicate the use of the SBET with written advice on exact dosages based on weight (Table 2). For families, dosages for each family member should be provided.

It is important to emphasize that so far there is no (safety) study about the SBET strategy and that this is urgently needed.

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