Bradley D J, Bannister B
PHLS Malaria Reference Laboratory, London School of Hygiene and Tropical Medicine, WC1E 7HT.
Commun Dis Public Health. 2001 Jun;4(2):84-101.
These guidelines on malaria prevention are designed to aid health care workers who advise travellers, particularly those who will be overseas for less than a year. The present, and any future, revisions are the responsibility of the Advisory Committee on Malaria Prevention in UK travellers (ACMP; membership given at the end of the Guidelines). This has replaced the consensus meetings which produced earlier versions from 1980 to the the 1997 version. The guidelines are in three parts. The first part is a summary that emphasises modifications to the advice given in the last set of guidelines, published in 1997. The second part discusses the issues addressed in formulating the guidelines. Oversimplified lists of recommendations by country can be misleading. The second part also addresses the health care worker's consultation with prospective travellers. Doctors, practice nurses and pharmacists are asked to read this section to ensure that due attention is paid to the traveller's history and destination. The third part gives specific recommendations for travellers to specific destinations and some details of individual drugs. Fuller information on some drugs now less used was given in earlier versions of the guidelines. These guidelines reflect experienced professional opinion. Data are inadequate for unequivocal views to be given on several issues, but all available evidence has been taken into consideration. There is often a range of acceptable options, but to meet the requests of general practitioners the guidelines aim to give one recommended option and state the alternatives, suggesting when and how different regimens can be used to good effect. However, there are now several options for effective prophylaxis of highly chloroquine-resistant falciparum malaria, and the choice between them will depend on details of the journey and individual preferences. Decisions on the terms under which different drugs are licensed for use are the responsibility of the Licensing Authority, advised by the Committee on Safety of Medicines and not of the ACMP. The guidelines should therefore be read as a supplement to and not as a substitute for the relevant data sheets. In concept and practice, chemoprophylaxis lies somewhere between vaccinations (for which people expect governments to lay down schedules) and treatment of ill people (which is determined by individual clinical need and choice). The risks of malaria need to be balanced against the risks of the preventive measures, on the basis of the data available. Travellers may ask for an explanation of these risks and doctors and practice nurses need to be well informed and able to present this information to travellers. The second part of these guidelines may also be of use to prospective travellers who wish to read about the options themselves. All readers are recommended to read part two in its entirety to get a balanced picture.
这些疟疾预防指南旨在帮助为旅行者提供建议的医护人员，尤其是那些将在海外停留不到一年的人。本指南及未来的任何修订均由英国旅行者疟疾预防咨询委员会（ACMP；指南末尾列出了成员名单）负责。该委员会已取代了曾制定1980年至1997年各版本指南的共识会议。本指南分为三个部分。第一部分是总结，重点强调了对1997年发布的上一套指南中所提建议的修改。第二部分讨论了制定指南过程中涉及的问题。按国家列出的过于简化的建议清单可能会产生误导。第二部分还涉及医护人员与潜在旅行者的咨询。要求医生、执业护士和药剂师阅读本节内容，以确保充分关注旅行者的病史和目的地。第三部分针对前往特定目的地的旅行者给出了具体建议，并介绍了个别药物的一些细节。关于一些现已较少使用的药物的更全面信息在指南的早期版本中已有提供。这些指南反映了专业经验意见。在一些问题上，数据不足以给出明确观点，但已考虑了所有可得证据。通常有一系列可接受的选择，但为满足全科医生的要求，指南旨在给出一个推荐选项并说明替代方案，同时指出何时以及如何使用不同方案能取得良好效果。然而，目前对于高度耐氯喹的恶性疟原虫疟疾有多种有效的预防选择，具体选择将取决于旅行细节和个人偏好。关于不同药物的使用许可条款的决定由药品许可当局负责，药品安全委员会会提供建议，而非由ACMP负责。因此，应将本指南视为相关药品说明书的补充，而非替代品。在概念和实践中，化学预防介于疫苗接种（人们期望政府制定接种计划）和治疗病人（由个体临床需求和选择决定）之间。需要根据可得数据，在疟疾风险与预防措施风险之间进行权衡。旅行者可能会要求解释这些风险，医生和执业护士需要充分了解情况并能够向旅行者提供这些信息。本指南的第二部分对于希望自行了解相关选择的潜在旅行者可能也有用。建议所有读者完整阅读第二部分，以全面了解情况。
