[Reserve treatment for malaria: pros and cons]

Any discussion of stand-by treatment will raise several questions: to whom should it be prescribed? which drugs are advised for stand-by treatment, according to the expected sensitivity of the parasites, the chemoprophylaxis and the possible side effects of the drugs chosen? what information should be given to a potential user? under what circumstances should stand-by treatment be used? how can the use of stand-by treatment and its efficacy be evaluated? are there any data for the stand-by treatment in literature? what are the pros and cons for the use of stand-by treatment? what is the place for stand-by treatment in today's array of antimalarial treatment? All of these questions were discussed at a round table stating that while stand-by treatment is an important element in malarial prevention for travellers, it must not become synonymous with self-treatment. An initial prescription of stand-by treatment is essential with the physician informing the user of the conditions for its use and its risks. The use of stand-by treatment does not exempt the traveller from rigourously carrying out the extensive recommended preventive measures. If, in spite of these precautions, a traveller does come down with a presumed malarial fever, the use of stand-by treatment should not prevent him from consulting a physician. A physician is in the best position to indicate an available stand-by treatment which should be considered as a back-up treatment. Self-treatment should only be considered as a last resort given its limitations. In all cases, it is indispensable to consult a physician.