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01.12.2012 | Research | Ausgabe 1/2012 Open Access

Malaria Journal 1/2012

Therapy of uncomplicated falciparum malaria in Europe: MALTHER – a prospective observational multicentre study

Malaria Journal > Ausgabe 1/2012
Olivier Bouchaud, Nikolai Mühlberger, Philippe Parola, Guido Calleri, Alberto Matteelli, Gabriele Peyerl-Hoffmann, Frédéric Méchaï, Philippe Gautret, Jan Clerinx, Peter G Kremsner, Tomas Jelinek, Annette Kaiser, Anna Beltrame, Matthias L Schmid, Peter Kern, Meike Probst, Alessandro Bartoloni, Thomas Weinke, Martin P Grobusch
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1475-2875-11-212) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare they have no conflict of interest.

Authors’ contributions

OB contributed to the design of the study, contributed patient data and led writing the paper. NM designed the database, served as the study data manager, analysed the data and contributed to writing of the first draft and final version of the paper. AM contributed to the design of the study, to patient data collection and to the writing of the final paper. All other authors contributed patient data and contributed to the writing of the final paper. MPG conceived and designed the study, served as Principal Investigator and contributed to the writing of the first draft and final version of the paper. All authors read and approved the final manuscript.



Malaria continues to be amongst the most frequent infectious diseases imported to Europe. Whilst European treatment guidelines are based on data from studies carried out in endemic areas, there is a paucity of original prospective treatment data. The objective was to summarize data on treatments to harmonize and optimize treatment for uncomplicated malaria in Europe.


A prospective observational multicentre study was conducted, assessing tolerance and efficacy of treatment regimens for imported uncomplicated falciparum malaria in adults amongst European centres of tropical and travel medicine.


Between December 2003 and 2009, 504 patients were included in 16 centres from five European countries. Eighteen treatment regimens were reported, the top three being atovaquone-proguanil, mefloquine, and artemether-lumefantrine. Treatments significantly differed with respect to the occurrence of treatment changes (p = 0.005) and adverse events (p = 0.001), parasite and fever clearance times (p < 0.001), and hospitalization rates (p = 0.0066) and durations (p = 0.001). Four recrudescences and two progressions to severe disease were observed. Compared to other regimens, quinine alone was associated with more frequent switches to second line treatment, more adverse events and longer inpatient stays. Parasite and fever clearance times were shortest with artemether-mefloquine combination treatment. Vomiting was the most frequent cause of treatment change, occurring in 5.5% of all patients but 9% of the atovaquone-proguanil group.


This study highlights the heterogeneity of standards of care within Europe. A consensus discussion at European level is desirable to foster a standardized management of imported falciparum malaria.
Additional file 1: Main characteristics of 504 malaria patients in different European settings according to their treatment regimen. (PDF 1 MB)
Authors’ original file for figure 1
Authors’ original file for figure 2
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