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 emergency treatment. DRUGS FOR STANDBY TREATMENT
The following drugs may be recommended as standby emergency treatment:
Sulfadoxine-Pyrimethamine (Fansidar®) 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
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:
* mild hearing impairment (notably high tone deafness) * tinnitus * headache * nausea
* slight visual disturbances (occurring in up to 70% of patients)
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
13 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.
The guidelines are endorsed by the Medical Association of South Africa. |
