STANDBY EMERGENCY TREATMENT OF MALARIA
Standby treatment describes the use of
antimalarial drugs carried for self administration when malaria is suspected and prompt medical attention is not available. It is usually recommended if a traveller is going to stay for an extended period of time in an area with no medical care. It is only an option in clearly defined situations when being given with clear oral and written guidelines.
Advice on standby treatment should be obtained before entering the
area. The drugs for self administration are used when fever and flu-like symptoms occur, and malaria is the probable cause. The treatment course should be completed and antimalarial prophylaxis should be resumed 7 days after the first treatment dose. Medical advice should still be sought at the earliest opportunity after self treatment.
Two rapid identification tests for malaria are now available and can be helpful in diagnosing
malaria before standby treatment is administrated.
Both the plasma reagent dipstick13 (Parasite-F®) and the rapid immunochromatographic test (ICT Malaria P.f.®) are only suitable for P. falciparum diagnosis.
Most places in South Africa have adequate medical facilities thus obviating the need for standby
DRUGS FOR STANDBY TREATMENT
The following drugs may be recommended as standby emergency treatment:
This drug is relatively safe if taken for (single dose) standby treatment, without medical
supervision. There is a limited risk of severe cutaneous adverse effects if used as a single dose therapy. Since sulfadoxine is a sulphonamide, it is contraindicated in
patients exhibiting sulphonamide hypersensitivity.
Quinine is only recommended for standby treatment if a person cannot
take sulfadoxine-pyrimethamine. Since major adverse effects can occur, it should not readily be used without a medical practitioner's supervision. It may cause minor adverse effects such as:
Major side effects include:
Quinine toxicity presents with CNS disturbances (visual and auditory
most common manifestations) and cardiovascular abnormalities (hypotension, heart block, ventricular arrhythmias), which can be confused with severe (complicated) malaria.
Halofantrine should be administered on an empty stomach to
prevent toxicity, since its administration with a fatty meal has been shown to increase the rate of absorption six-fold. A significant breakthrough rate after the recommended three dose regimen necessitates an additional course one week after the initial therapy, especially in non-immune patients.
* Halofantrine should not be administered after mefloquine has been taken for
chemoprophylaxis or treatment due to the additive cardiotoxicity.
* Halofantrine should not be used in patients with a known family history of
congenital QTC prolongation. Therefore, halofantrine should only be used as
emergency self-treatment in patients known to have normal QTC intervals. These patients must be carefully counselled on the dosing and method of administration since prolongation of the QTC interval may result in heart block.
DIAGNOSIS AND TREATMENT OF MALARIA
no precautionary measures are 100% effective, malaria
can still be contracted in spite of taking preventive
measures. Any person resident in, or returning
from, a malaria risk area who develops fever and flu-like
symptoms should immediately consult their medical practitioner
and mention that they have been in a malaria area. Symptoms
can occur up to six months after leaving a malaria
Some of the following symptoms usually occur: fever, rigors, headache,
sweating, tiredness, myalgia (back and limbs), abdominal pain, diarrhoea, lost of appetite, orthostatic hypotension, nausea, slight jaundice, cough, enlarged liver and spleen (sometimes not palpable). The patients should be tested for malaria. In the majority of cases, examination of blood smears will reveal malaria parasites. If not found initially, further specimens should be examined by an experienced laboratory before the infection is excluded, as false negatives may be found on initial examination.
Treatment should be given immediately according to the recommendations in the booklet: Guidelines for the Treatment of Malaria, published by the
Department of Health, 1996.