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Valérie Briand, Olivier Bouchaud, Arnaud Fontanet, Reply, Journal of Travel Medicine, Volume 15, Issue 1, 1 January 2008, Pages 60–61, https://doi.org/10.1111/j.1708-8305.2007.00180_2.x
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Extract
Response to Letter:
We read with interest the commentary of Bottieau and colleagues 1 about our article and share with them the opinion that a significant proportion of patients with uncomplicated imported falciparum malaria could be safely treated outside the hospital.
Although the issue is of importance and still debated, the reliability of ambulatory—versus hospital—management for imported malaria has not yet been fully assessed. The best study design would be a randomized trial comparing ambulatory versus hospital care among patients with uncomplicated imported falciparum malaria. In the absence of such trials, one has to rely on observational studies such as that of Bottieau and colleagues or ours 2 to improve existing guidelines for patients management. We were reassured that several predictors of parasite clearance time (PCT) we identified in our study were also predictors for a non‐severe course of malaria in the study of Bottieau and colleagues (no criteria of malaria severity, as defined by the World Health Organization; absence of vomiting; and initial parasitemia less than 1% of red blood cells). Bottieau and colleagues identified an additional criteria, the initial bilirubin level, that can predict the course of treated malaria. As suggested by them, we retrospectively tested the association between initial level of total bilirubin and PCT. The bilirubin level was determined in 281 (70%) of the 400 patients who were included in our analysis. We found that a normal initial bilirubin level (<1mg/dL) was indeed significantly associated with a shorter PCT [−10 h (−20 to −1), p= 0.03]. However, this association did not remain significant when adjusting for the indicators we found associated with PCT in multivariate analysis [−1 h (−9 to 6), p= 0.82]. In particular, the association disappeared when we introduced the variable parasitemia in the model, suggesting that the two criteria are closely related.
