Hold That Buzz: Timely Malaria Medication Access in New Orleans, LA

Background: Malaria is a global health concern. Given increasing global travel and migration, hospitals may struggle to meet immediate malaria treatment needs resulting in serious and potentially fatal outcomes. New Orleans is a mid-size city with a significant immigrant population, large tourism industry, major academic centers with international faculty and many international industries with a diversity of medical systems. Assessing malaria medication accessibility across various clinical settings would address major gaps in treatment capacity and efficacy.

Methods: Inpatient pharmacy directors and formularies at three New Orleans-area hospitals (an academic medical center, a large safety-net hospital and a community hospital) were queried about their first-line antimalarial agents in stock within the hospital pharmacy, time needed to obtain both IV and PO first line antimalarial agents, and barriers to expanding the formulary (including cost, number of cases, side effects, and shelf life of medications). The queries were carried out using a medications order system survey.

Results: First-line IV medications could not be provided in <24 hours at any of hospitals surveyed; however, all provided a form of first-line antimalarial coverage for non-severe malaria. Two of the three hospitals provided oral artemisinin-based combination therapies (ACTs) on their hospital formulary available in <24 hours and all three provided ACTs on their outpatient formularies. All hospitals surveyed could obtain intravenous ACTs from the CDC within 24-48 hours. Barriers identified for availability of oral ACTs and other antimalarials included the number of cases seen (reported by all 3 hospitals) and cost of medication (reported by 1 hospital).

Conclusion: Oral first-line malaria treatments including ACTs could be obtained in the surveyed hospitals within 24-48 hours and all hospitals could obtain IV ACTs from the CDC within 24-48 hours. The main barrier preventing hospitals from providing ACTs and other anti-malarial medications was infrequency of malaria cases; cost was a secondary concern. This information can be used in attempts to educate hospital systems about appropriate and timely malaria treatment, inform policy and procedures, and design systems to track malaria diagnosis and treatment.