Coartem^® /Riamet^®

Riamet^®

Anyone travelling to an area with endemic malaria is at risk from infection. Travellers should be aware that all prophylactic drugs should be taken with unfailing regularity for the duration of the stay in the malaria risk area, and must be continued for up to 4 weeks after the last possible exposure to infection for mefloquine.⁴ Residents and long-stay travellers in a risk area rarely use long-term chemoprophylaxis - mainly because of adverse events related to antimalarial drugs.⁵

Poor compliance and growing resistance of the parasite to various drugs mean that prophylaxis often fails and acute treatment becomes necessary. For travellers, the risks of malaria need to be balanced against the risks associated with the preventative measures based on the data available.

Treating malaria

The aim of treatment is to fight an established parasite infection and includes:

• elimination of the parasites
• supportive measures to overcome morbidity associated with infection
• monitoring - to ensure early diagnosis and treatment of complications that can lead to death within hours.

Acute treatment is the ‘traditional’ role for antimalarial drugs. Current antimalarials are effective and indispensable for eliminating the malarial parasite. However, the range of drugs is limited, and reduced efficacy due to increasing resistance, relatively poor tolerability and a cumbersome dosage regimen have led to the drive to develop new compounds. Riamet^® is a well-tolerated and effective combination therapy that provides an important addition to the treatment armamentarium against malaria.^{6, 3}

Standby emergency treatment

Standby emergency treatment is for self-administration by patients when fever and flu-like symptoms occur after being at least 1 week in an area with a malaria risk and where it is not possible to obtain medical attention within 24 hours. Although most travellers will be able to obtain medical attention within 24 hours, the WHO now recommends that travellers staying in remote locations in endemic areas where it is not possible to obtain medical attention within 24 hours should carry antimalarial drugs for emergency self-administration.⁴

Standby emergency treatment may also be indicated for travellers in some occupational groups, such as aircraft crews, who make frequent short stops in endemic areas over a prolonged period of time. These travellers may choose to reserve chemoprophylactic drugs for high-risk areas only.

In some cases, standby emergency treatment combined with rigorous protection against mosquito bites may be indicated for those who travel for 1 week or more to remote rural areas where there is very little likelihood of multi-drug resistant malaria and the risk of prophylaxis outweighs the risk of contracting malaria.

Travellers prescribed standby emergency treatment should be given clear and precise written instructions on the recognition of symptoms, when and how to take the treatment, the treatment regimen, possible side effects, and the possibility of drug failure.

‘SET [standby emergency treatment] has a place in the prevention of malaria in travellers and should be seen as an important ‘third option’ alongside bite prevention and chemoprophylaxis. It is not suitable for everyone but problems with patient compliance and parasite resistance to chemoprophylaxis make it a vital element in ensuring a traveller has the best possible malaria protection.’ ⁷

Riamet^® - overview of product characteristics

Riamet^® :

• is highly effective against acute, uncomplicated malaria caused by P. falciparum in areas of multi-drug resistance  
• eliminates parasites and symptoms significantly faster than most current antimalarials^{1, 2}
• is a fast-acting emergency therapy for non-immune travellers
• is rapidly gametocytocidal, helping to reduce transmission
• is well tolerated and safe, particularly when compared with most current established antimalarials³
• is an easy fixed-dose combination treatment:
  ~ simplifying compliance
  ~ tested by GCP (Good Clinical Practice) standards.

Riamet^® is an oral formulation. Each light yellow uncoated tablet contains a fixed combination of artemether and lumefantrine in a 1:6 ratio.