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Emergency standby treatment in malaria

Last reviewed 13 Feb 2023

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:

(1) Public Health England (PHE) 2013. Guidelines for malaria prevention in travelers from the United Kingdom

Malaria

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Emergency standby treatment in malaria

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