Stand-by treatment for malaria.

Taking along an antimalarial drug fora traveler visiting an endemic area ca n be a good idea in the event of a suspected malarial illness while abroad. This stand-by medication should be prescribed before departure to a travel er compliant with protective measures against mosquitoes. This curative dru g is indicated either for short but repeated exposures (aircrews) or for a minimal stay of one week in a place where diagnostic and therapeutic facili ties are more than 12 hours away. Other factors which determine the need fo r stand-by medication include the risk of acquiring malaria infection, depe nding on both the level of vectorial transmission and the indication or not of a chemoprophylaxis. To choose the drug for stand-by treatment, the foll owing points must be examined: - the type and intensity of chemoresistance of Plasmodium falciparum in the visited area, - the concomitant use of a chemoprophylactic regime, - the traveler's health status, - the efficacy and toxicity of available drugs. According to the few reported surveys, many travelers take along a drug for emergency treatment, which they use at a slightly higher rate than the est imated malaria risk would require in the visited area. The future of stand- by treatment mostly depends on the availability of a reliable and simple se lf-diagnosis test and of a new antimalarial drug, both efficient and safe. (C) 1999 Editions scientifiques et medicales Elsevier SAS.