The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Letter to the editor

Editor, – The article 'Malaria prevention in the expatriate and long-term traveller' (Aust Prescr 2002;25:66-9)was good but deficient in a few areas. I am a pharmacist living in a malaria endemic area of Nigeria. By virtue of this I am aware of other ways of managing malaria as we are faced with this terrible disease for a lifetime.

In the section on the malaria standby treatment regimens, attention was not drawn to the use of dihydroartemisinine - a novel drug developed from the malaria herb Qinghaosu in China. This drug happens to be the most effective and safest anti-malarial compared to the others listed in the article. It has a very fast onset of action and adverse effects that are not debilitating.

I would emphasise the life cycle of the plasmodium parasite, as the dormanthypnozoites and gametocyte forms in the liver and blood respectively contribute significantly in reinfection and transmission of the diseases. The need for a radical cure when the expatriate or traveller returns home means there is a possible role for a drug like primaquine.

In conclusion, these aspects would definitely add the cherry on the cake and make the article well balanced.

Bamgboye Olusegun Raymond
Department of Clinical Pharmacy
University of Benin
Benin City, Edo State

Authors' comments

Dr Daniel O'Brien and Dr Beverley-Ann Biggs, authors of the article, comment:

We acknowledge the comments of Bamgboye Raymond regarding our article 'Malaria prevention in the expatriate and long-term traveller'. Indeed dihydroartemisinine is used widely throughout malarial endemic countries as a safe and effective treatment for malaria. However, our paper was written for Australian health practitioners, and as this medication is not currently registered for use in Australia, it was not included.

We also agree that treatment of malaria due to Plasmodium vivax and Plasmodium ovale requires consideration of eradication of the liver hypnozoites to reduce the chance of recurrent infection in those who have left the endemic area, and are unlikely to be re-exposed in the near future. However our article deals with emergency standby treatment for those developing malaria in endemic areas. Here there is little value in treatment with drugs such as primaquine due to the likelihood of reinfection.