New italian guidelines for malaria prophylaxis in travellers to endemic areas

Background and Methods As a consequence of the rapid
evolution of malaria prophylaxis recommendations
throughout the world, the Italian Society of Tropical
Medicine (SIMET—Societa` Italiana di Medicina Tropicale)
has set up a working group in charge of preparing a
new national guideline. Other scientific societies interested
in the topic were also involved in the project.
Results and Conclusions The group stated that awareness
about malaria risk and characteristics, as well as protection
from mosquito bites, are recommended for all travellers
visiting malaria-endemic countries. The risk and benefit of
malaria chemoprophylaxis must be carefully balanced
before prescribing drugs: the disease-related risk must
outweigh the possibility of drugs’ side effects. As a general
rule, malaria pills are the first choice for travellers to highrisk
areas, such as sub-Saharan Africa, Eastern India,
Myanmar, Eastern Indonesia, Papua New Guinea and, with
some limitations, South-East Asia, and the Amazon part of
Venezuela, Guyana and French Guyana. However, several
other factors, such as itinerary, season, duration of trip,
availability of insect bite protection, pre-existing conditions
and compliance, must be taken into account. In lowrisk
areas, stand-by emergency treatment is the first option.
In minimal-risk areas and in Plasmodium vivax areas, a
prompt diagnosis only is advised (Central America, South
America outside the Amazon basin, Middle East, China,
Thailand, Nepal). Recommendations may be modified
when particular groups of travellers are concerned, such as
long-term residents, visiting friends and relatives, patients
with pre-existing conditions, pregnant women and children.