[Principles and practice of malaria chemoprophylaxis and of malaria emergency medication for travelers]

Abstract

Malaria chemoprophylaxis and stand-by medication, avoidance of being bitten by mosquitoes, and instruction on the mode of infection, symptoms of disease and appropriate steps if malaria is suspected, are all crucial for malaria prevention in travellers. Drugs used for chemoprophylaxis do not prevent infection but help to avoid multiplication of parasites and disease. If a traveller is on stand-by medication, he decides himself according to symptoms when to take it; nevertheless, he is advised to see a doctor afterwards. Length of stay in an endemic area, health status of the traveller, malaria transmission rate and drug resistance determine the strategy of malaria prevention to be chosen. Risk-benefit analysis of a chemoprophylactic regimen compares the risk of severe side effects of the drug with that of a life-threatening malaria attack. Stand-by medication presents an alternative, if the former outweighs the latter. The Swiss Working Group on Medical Counselling for Travellers updates guidelines for malaria prophylaxis. Recommendations for individual countries are regularly published by the Swiss Health Authorities (BAG). If chemoprophylaxis fails or if a malaria attack is not fully covered by stand-by medication, diagnosis and treatment can cause problems.