Treatment of Plasmodium falciparum malaria in the nonendemic setting: a narrative review of toxicity, failure and emerging resistance

Several factors (e.g. lack of prior immunity, older age, overweight, comorbidities, and comedication) distinguish travelers from people residing in malaria-endemic areas. Yet, current uniform treatment recommendations across settings do not address many considerations that predominantly affect nonimmune travelers with malaria. This population may also be more vulnerable to complications of malaria as reduced susceptibility to key antimalarials spreads. We propose specific adaptations to the management of malaria in travelers, with a focus on structured clinical follow-up to detect toxicity and failure, and on systematic genomic surveillance in concert with existing initiatives in endemic countries.