Accessibility to antimalarials in Spanish hospitals: analysis of a national survey

Despite the eradication of malaria as a locally transmitted disease in Spain, the incidence of imported cases continues to rise, with Plasmodium falciparum representing the majority of infections. Prompt access to effective antimalarial treatment, particularly artemisinin-based therapies, is crucial to prevent severe outcomes. However, the unguaranteed and irregular availability of these drugs poses a potential threat to patient management. The objective of this study was to evaluate the availability of antimalarial drugs and their procurement times in Spanish hospitals.

A nationwide cross-sectional survey was conducted between September 2023 and January 2024. Hospital pharmacists were invited via the Spanish Society of Hospital Pharmacy to report on antimalarial stock levels and procurement times. Data were analysed using descriptive statistics and chi-square tests, stratified by hospital size and the presence of malaria treatment protocols.

A total of 46 hospitals participated. Intravenous artesunate, the first-line treatment for severe malaria, was stocked in 74% of hospitals, but only 60% could acquire it within 24 h on weekdays if not already in stock or more doses were required. Availability was higher and acquisition times were shorter in large hospitals (> 500 beds) and in institutions with established protocols for malaria treatment. Artemisinin-based combinations, such as piperaquine-dihydroartemisinin, and atovaquone-proguanil were more accessible, but weekend acquisition remained limited.

The study highlights substantial variability and critical delays in antimalarial drug availability across Spanish hospitals. Enhancing access requires national stockpiling strategies, broader implementation of standardized treatment protocols, and improved procurement systems. These measures are vital to ensure timely treatment and reduce morbidity associated with imported malaria.