Standby Emergency Treatment for Malaria (SBET) – A good alternative

In the past, when travelers planed to visit tropical countries, their doctors would recommended antimalarial medication to prevent malaria if their destination were malaria risk area. So generally, the doctors had 2 options i.e. prescribe or not prescribe antimalarial prophylaxis depend the area.

The concept of “Standby emergency treatment of malaria (SBET)” is relatively new. It is a good alternative in the low risk area of malaria. In that area, the chance for the traveler to actually get malaria while they travel is low or very low. So the benefit of antimalarial prophylaxis is minimum. Such as, if the estimate risk to get malaria in area A is equal to 1 in 10,000. If travelers take chemoprophylaxis, the risk may reduced to 1:100,000. Please be informed NO antimalarial prophylaxis is 100% effective. So the risk is never be zero.

You’ll see, we could reduce the chance to get malaria from 1:10,000 to 1:100,000 when using chemoprophylaxis. But keep in mind that, if you use chemoprophylaxis, you may have some side-effects from malaria medication. Although most people are doing well with malaria medication, some may develop side effect which may be severe. That’s a risk also.

So we have to consider the risk to develop severe side-effect of antimalarial medication and the risk to get malaria. Benefit from medication should be outweigh their risk. For example, if you travel in high risk area such as Sub-Saharan Africa or Papau New Guinea, malaria risk is so high, so antimalarial prophylaxis is a good and reasonable option.

But if the chance to get malaria is very low, what should we do. Here’s come the concept of Standby Emergency Treatment.

Standby emergency treatment of malaria is another strategy to help the travelers safe from malaria. It is not the medication for prevention of malaria. That means there is no need to take the medication before or during trip in order to prevent malaria. In fact, it is a medication set for treatment of malaria. It can be used in case of emergency only. Just take this medication once when you develop fever while or after traveling in malaria risk area. And you could not seek for any medical care to check your blood.

In that case, there is no way to know that you really get malaria or not. However when consider the fact that malaria especially P.falciparum is fatal if not promptly treated. So SBET may be life-saving.

Doctors may prescribe SBET in some circumstances such as

When the risk of the travelers to get malaria is low (if it is high, we should consider prophylaxis regimen)
The travel destinations is remote and medical care may not be available
Travelers must be advised and fully understood when and how to use SBET

Consider to use SBET when you

Has been stayed in the malaria risk area for more than 1 week.
Has fever with/without chill, abdominal pain, N/V, muscle ache, headache
Medical services not available within 12-24 hrs.
Take medications as prescribed
Seek for medical care as soon as possible even after self-treated (to confirm diagnosis)

Nowadays the concept of SBET is gaining more acceptance from many authorities especially in the use of low risk area such as in Southeast Asia. Some nataional guideline such as in German and Swiss guideline prefer SBET to chemoprophylaxis in low risk area. World health organization (WHO) also mention about the use of SBET in Southeast Asia as attached below;

Furthermore, SBET – combined with protection against mosquito bites – may be indicated for those who travel for 1 week or more to remote rural areas where there is multidrug-resistant malaria but a very low risk of infection, and the risk of side-effects of prophylaxis may outweigh that of contracting malaria. This may be the case in certain border areas of Thailand, Viet Nam and neighbouring countries in South-East Asia as well as parts of the Amazon basin.

Successful SBET depends crucially on travellers’ behaviour, and health advisers need to spend time explaining the strategy. Travellers provided with SBET should be given clear and precise written instructions on the recognition of symptoms, when and how to take the treatment, possible side-effects, and the possibility of drug failure. If several people travel together, the individual dosages for SBET should be specified. Weight-based dosages for children need to be clearly indicated. Travellers should realize that self-treatment is a first-aid measure, and that they should still seek medical advice as soon as possible.
From: WHO Green Book, international travel and health 2009

In our opinion, SBET is a good alternative for travelers in Southeast Asia and we do not recommend antimalaria prophylaxis in our region. However, travelers should be informed how and when to use SBET appropriately. Moreover, travelers should not overlooked the importance of mosquito bite prevention and the necessary to seek for medical care even after self-treated.

Continue reading in part 3 ( SBET regimen in Thailand and Southeast Asia )