The more adventurous traveller going to places where rapid access to medical advice is not available may wish to carry a course of anti-malarial ‘stand-by’ treatment. This should be taken if symptoms of possible malaria develop, but it is not a substitute for medical care, and it is important to seek medical advice and a blood film. There are malaria diagnostic kits available which enable travellers to do a blood test on themselves to decide if their illness is due to malaria or not.
However, studies have shown that travellers have difficulties performing and interpreting these tests when they are shivering with fever! We think it is safer to treat presumptively and seek medical advice than to try to do a test which may not be interpreted correctly and which may then delay taking life-saving malaria treatment.
The stand-by regime will depend on the drug resistance in the area which you are visiting and on which anti-malarial drugs are being taken. It is advisable to seek specialist advice.
Some examples of stand-by medications are three Fansider tablets taken at the same time are the most convenient, but this is not suitable for people who are allergic to sulphur drugs.
Two Mefloquine tablets taken together followed by two tablets 12 hours later. The main problem with this dose of mefloquine is severe nausea and vomiting and the increased risk of neuropsychiatric side-effects.
Quinine, adult dose: two tablets, three times a day for three days, and tetracycline, adult dose: one tablet, four times a day for seven days, are recommended as stand-by medication in areas with a lot of drug resistance. Malarone may be recommended as a stand-by treatment. The adult dose is four tablets daily for three days.
The risk of malaria infection poses a real and significant problem for the traveller. It is essential that pre-travel advice is sought and that each traveller takes anti-mosquito bite measures and decides which anti-malarial drug regimen is suitable for them. It is important to remember that no anti-malarial drug is 100 per cent effective and any illness, especially if there is fever, must lead to a blood test to exclude malaria infection. It is also important to inform the doctor that you have been to a malaria area within the preceding two years. If this advice is ignored, the diagnosis of malaria will not be considered until too late, and tragic and preventable deaths will continue to occur.
To summarise the key points, you must take measures to prevent mosquito bites: repellents, impregnated bed nets, suitable clothing, sleep in a screened room with knock-down insecticides, coils or electronic vapourisers. Take appropriate anti-malarial drugs regularly and complete the course. Remember that no prophylaxis is 100 per cent effective and, in the event of any illness, especially if there is fever, seek immediate diagnosis, with a blood film, and treatment.
Finally, and most importantly you should consider carrying a ‘stand-by treatment’.