Diagnosis, treatment and prevention of malaria in travellers – Related resources

Cochrane reviews

• SPf66 vaccine may provide a modest (about 25%) protection from Plasmodium falciparum malaria, but benefit has been only observed in trials outside Africa . Combination of amodiaquine and sulfadoxine-pyrimethamine for uncomplicated malaria appears to reduce treatment failure compared to the latter drug alone. The effectiveness depends on existing levels of parasite resistance to the individual drugs .
Amodiaquine is more effective than chloroquine for parasite clearance, but it appears not to be more effective than sulfadoxine/pyrimetamine .
• High first dose quinine regimen appears to reduce fever clearance time and parasite clearance in severe malaria . Chlorproguanil-dapsone (three-dose, 2 mg) may have some benefit over sulfadoxine-pyrimethamine for treating malaria but additional trials are required. Potentially serious adverse effects are more common with chlorproguanil-dapsone .
• Artesunate (10 mg) plus mefloquine (25 mg/kg) performs better than mefloquine alone for treating uncomplicated falciparum malaria in areas with low malaria transmission .
• Sulfadoxine-pyrimethamine plus amodiaquine appears to perform better than sulfadoxine-pyrimethamine plus artesunate when treating uncomplicated malaria. Local resistance patterns have to be carefully considered .
• Prophylaxis and intermittent treatment with antimalarial drugs reduce clinical malaria and severe anaemia in preschool children. There is insufficient evidence to detect an effect on mortality .
• Drugs given routinely for malaria during pregnancy for low parity women reduce severe antenatal anaemia in the mother, increase birthweight and may reduce perinatal deaths .
• Routine phenobarbitone in cerebral malaria appears to cause more deaths compared with placebo, although it is effective for convulsions .
• Electronic mosquito repellents appear not to be effective in preventing mosquito bites and malaria infection .
• The evidence on malaria treatment options in pregnancy is insufficient for conclusions. Some combination treatments appear to be effective at treating malaria in pregnancy; however, safety data are limited .
• Arteether seems not to be any worse than quinine for treating severe malaria in children, although the evidence is insufficient .
• Steroids as an adjunct to antimalarial treatment may not reduce mortality in cerebral malaria compared to antimalarial treatment alone, and appear to increase gastrointestinal bleeding and seizures .
• Artemisinin-based combination therapies (ACTs) appear to be highly effective for treating uncomplicated malaria. Dihydroartemisinin-piperaquine appears to be another effective first-line treatment for P. falciparum malaria .

Other evidence summaries

• The Parasight F test may be useful in the diagnosis of malaria, but it cannot replace microscopy .
Artemether appears to be as effective as quinine in the treatment of severe malaria .
• Addition of 3 days' artesunate to standard antimalarial treatments substantially reduces treatment failure, recrudescence and gametocyte carriage .

Other Internet resources

• WHO malaria site Malaria. ORPHA673
• Centers for Disease Control and Prevention, USA. Treatment of Malaria: Guidelines For Clinicians (United States) Part 3: Alternatives for Pregnant Women and Treatment of Severe Malaria

Literature