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- Teach travelers about the etiology, management, prognosis, and prevention of malaria.
- Advise successfully treated patients about the risks of relapse and infection and the importance of secondary prevention.
- Counsel and provide treatment drugs to travelers to isolated locations that lack rapid access to medical attention.
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Teach travelers about the etiology, management, prognosis, and prevention of malaria.  |
- Inform travelers that:
- Malaria is transmitted by mosquito bites that can be quite inapparent or even unnoticed
- Malaria can develop at any time after 1 week in a malarious area
- Locally purchased antimalarial drugs may not be effective due to substandard manufacturing practices or outright counterfeiting
- Although malaria often presents initially with fever and flu-like symptoms, it can evolve rapidly into a life-threatening disease characterized by respiratory failure, coma, seizures, and renal failure
- Uncomplicated malaria requires immediate treatment observed in a hospital setting, if possible
- Management of severe malaria:
- Requires admission to an ICU for treatment and monitoring
- May require major interventions, such as blood transfusion, mechanical ventilation, and hemodialysis
- Although adequate treatment of uncomplicated malaria usually results in a cure, the prognosis of severe malaria is variable, from complete recovery to various complications such as neurologic deficits and renal insufficiency
| Background | Back to top
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Advise successfully treated patients about the risks of relapse and infection and the importance of secondary prevention.  |
- Advise patients:
- To complete their antimalarial regimen even if symptom resolution occurs early
- To contact their physician to request an alternative regimen if they cannot tolerate their medication (e.g., bitterness of quinine or GI distress from doxycycline) rather than discontinue it on their own
- To seek medical attention if they become febrile again, noting their previous malaria diagnosis and treatment
- That an episode of malaria does not make them immune to future episodes of the disease; thus, mosquito avoidance and repellent measures and chemoprophylaxis must be used during subsequent travel to malarious areas
- That they will not be acceptable blood donors until sufficient time has elapsed since their time spent in malarious areas, whether they acquired symptomatic malaria or not
- See figure Plasmodium Life Cycle, Recrudescence, and Relapse.
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Counsel and provide treatment drugs to travelers to isolated locations that lack rapid access to medical attention. |
- Provide travelers to isolated locations with stand-by antimalarial drugs for emergency self-treatment of fever and flu-like symptoms that occur at least 1 week after entering a malaria endemic area.
- Select stand-by antimalarial drugs based on the drug-resistance pattern of the area visited:
- Drug of choice: atovaquone-proguanil
- Alternative: artemether-lumefantrine (not available in the U.S.)
- Alternative in pregnancy: quinine sulfate
- Note that none of these regimens is currently registered for self-administered stand-by treatment in any country
- Advise persons receiving chemoprophylaxis that they should not attempt stand-by treatment with the same drug.
- Following completion of treatment, advise travelers to resume effective malaria prophylaxis within a few days of the last treatment dose; however, when the stand-by drug is quinine, advise travelers to resume mefloquine prophylaxis 1 week after the last treatment dose.
- Instruct travelers and their companions on the:
- Signs and symptoms of malaria
- Proper use and adverse effects of the treatment drug, which will differ from the prophylaxis drug
- Importance of seeking medical attention as soon as possible after the initiation of self-treatment
- See table Drug Treatment for Malaria.
| Background | Back to top
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| Harry Tagbor, MBChB, DrPH, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Rick M. Fairhurst, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Thomas E. Wellems, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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Malaria
