Travellers
The role of standby emergency treatment
Standby emergency treatment is taken by a traveller who:
- May become sick in a remote location and cannot easily reach a hospital or qualified health professional.
- May already be taking antimalarials for prophylaxis.
- May have to self-diagnose malaria based on non-specific clinical symptoms such as fever.
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 should carry antimalarial drugs for emergency self administration.1
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, 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 a very little likelihood of multi-drug resistant malaria and the risk of prophylaxis outweighs the risk of contracting malaria.
People prescribed standby emergency medication need to be given clear and precise written instructions on the recognition of symptoms, the treatment regimen, possible side effects and the action to be taken in the event of drug failure. Travellers should be made aware that self-treatment is a first aid measure, and that they should seek medical advice as soon as possible.1
Choice of standby emergency treatment depends on the area to be visited and the prophylactic drug to be used (if any).
Choice of standby emergency treatment according to recommended chemoprophylactic regimen1
Note. A drug selected for stand-by emergency treatment should always be different from the drugs used for prophylaxis, if any, and should be one to which no resistance has been reported in the countries to be visited (see WHO Country list - http://www.who.int/ith/countries/en/).
| Prophylactic drug | Appropriate standby therapy |
| None | Mefloquine Quinine Artemether and lumefantrinea Atovaquone/proguanila |
 |
|
| Chloroquine alone or with proguanil (only in pregnancy) |
Mefloquine Quinine |
|
|
| Mefloquine | Quinineb Quinine + doxycycline or tetracycline for 7 daysb |
|
|
| Doxycycline | Mefloquine Quinine + tetracycline for 7 days |
|
|
| Atovaquone/proguanil | Quinine + doxycycline/tetracycline for 7 days |
a There is limited experience at present on drug interactions of artemether/lumefantrine and atovaquone/proguanil with other antimalarial drugs. Therefore, if the patient is already taking an antimalarial as prophylaxis, these drugs should only be used if no other antimalarial treatment option is available.
b In these situations, mefloquine prophylaxis should only be resumed 7 days after the last self-treatment dose of quinine.
