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Emergency standby treatment in malaria

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emergency standby treatment

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Emergency standby treatment should be recommended for those taking chemoprophylaxis and visiting remote areas where they are unlikely to be within 24 hours of medical attention.

  • used in travellers who believe that they may have malaria (not as a replacement for chemoprophylaxis)
  • started in instances where it is impossible to consult a doctor and/or reach a diagnosis within 24 hours of the onset of fever.
  • written instruction should be given to the traveller to ensure appropriate use e.g. - symptoms suggesting possible malaria, including fever of 38°C and above, indications for starting the standby treatment, how to take it, expected side-effects and the possibility of drug failure
  • medical attention should be sought as soon as possible for full assessment and to exclude other serious causes of fever
  • drugs used for emergency standbytreatment should differ from the chemoprophylaxis agents in order to minimise drug toxicity and due to concerns over drug resistance

Standby treatment course should be completed and antimalarial cheoprophylaxis should be recommenced 1 week after taking the first treatment dose. Exception to this is in the case of mefloquine prophylaxis, which should be resumed at least twelve hours after the last treatment dose if quinine was used for standby treatment

If vomiting occurs:

  • within 30 minutes taking the standby treatment dose - a second full treatment dose of the antimalarial should be taken
  • after 30-60 minutes - half-dose

Antipyretics should be used to treat fever.

Advisory Committee on Malaria Prevention in UK Travellers (ACMP) recommended regimens for emergency standby treatment are as follows - please check ACMP for latest guidance


Situation for use

Standby treatment regine

Usual amount per tablet

Adult dosage

Chloroquine or
Multi-drug resistant
falciparum malaria

Artemether plus
lumefantrine
combination
preparation

20 mg artemether
plus
120 mg
lumefantrine

4 tablets initially, followed
by 5 further doses of 4
tablets each given at 8,
24, 36, 48 and 60 hours.
Total 24 tablets over
a period of 60 hours

4 tablets initially, followed
by 5 further doses of 4
tablets each given at 8,
24, 36, 48 and 60 hours.
Total 24 tablets over
a period of 60 hours

Chloroquine or
Multi-drug resistant
falciparum malaria

Atovaquone
plus Proguanil
combination
preparation

250 mg
atovaquone plus
100 mg proguanil

4 tablets as a single
dose on each of three
consecutive days

Chloroquine or
Multi-drug resistant
falciparum malaria

Quinine plus
Doxycycline

300 mg quinine
100 mg
doxycycline

Quinine 2 tablets 3 times
a day for 3 days,
accompanied by 1 tablet
of doxycycline twice daily
for 7 days

Recommended
where no
chloroquine
resistance present

NB Now applies to
very few
geographical areas

Chloroquine

155 mg
chloroquine base

4 tablets on days 1 &
2, 2 tablets on day 3

Pregnancy

Quinine plus
Clindamycin

300 mg quinine

150 mg
clindamycin

Quinine 2 tablets 3 times
a day for 5-7 days

Clindamycin 3 tablets
(450 mg) 3 times a day
for 5 days

Reference:


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