Selective ambulatory management of Plasmodium falciparum malaria in paediatric refugees.
BACKGROUND
Plasmodium falciparum (Pf) malaria is a leading cause of childhood mortality and morbidity. In developed countries, it is widely recommended that even patients with uncomplicated Pf malaria are hospitalised for at least 24 h, whereas ambulatory treatment is usual for uncomplicated infections in developing countries. This observational study assessed the safety of selective admission of paediatric refugees with Pf malaria in Australia.


METHODS
Data were collected on African humanitarian refugee children (<16 years of age) presenting with malaria between February 2005 and April 2006. Children were treated as outpatients if they fulfilled specific criteria devised to maximise the safety of outpatient management of this potentially life-threatening condition.


RESULTS
Ninety paediatric refugees were infected with P falciparum, of whom 56 were treated as outpatients. Of the 34 children admitted to hospital, four had parasite loads > or =4%. Most children were treated with oral atovaquone-proguanil. Eighty eight patients attended follow-up; all were compliant and none reported side-effects. One infant failed treatment and was subsequently readmitted; he did not meet criteria for severe malaria on either occasion and had been initially treated as an inpatient.


CONCLUSIONS
Using this protocol, outpatient management of refugee children with Pf malaria appears safe, with minimal complication and treatment failure rates. This approach has rationalised management of paediatric malaria in this carefully selected population and substantially reduced utilisation of hospital resources.
Cherian
Sarah
S
School of Paediatrics and Child Health, University of Western Australia and Paediatric Infectious Diseases and Refugee Health, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
Burgner
David
D
D000293:Adolescent; D000553:Ambulatory Care; D000962:Antimalarials / Q000627:therapeutic use*; D053626:Atovaquone / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use; D018512:Parasitemia / Q000188:drug therapy / Q000453:epidemiology; D010349:Patient Compliance; D002727:Proguanil / Q000627:therapeutic use; D011803:Quinine / Q000627:therapeutic use; D012036:Refugees
D000962:Antimalarials; D011803:Quinine; D002727:Proguanil; D015767:Mefloquine; D053626:Atovaquone