Larry Goodyer

Expert Review of the Evidence Base for Arthropod Bite Avoidance

Bite avoidance measures are commonly recommended to international travelers to help reduce the risk of various arthropod‐borne diseases. A key strategy is the use of repellents applied topically to skin or clothing which are considered in the first part of this review. Also advised are a variety of methods that employ the use of insecticides and physical barriers such as mosquito nets or oil preparations applied to the skin. In the following document, the authors considered some of the most widely used bite avoidance methods and identified the strength and quality of evidence that determined efficacy. The overall purpose of the review is to provide the available evidence, in a graded format, upon which to base recommendations for the selection of appropriate repellents and other methods of bite avoidance in those traveling overseas. The authors were asked to consider the effectiveness of the most commonly used active ingredients (AIs) in repellent formulations and methods of bite avoidance. The evidence base considered protection against nuisance biting insects, reduction in the incidence of arthropod‐borne diseases, and safety profile. Effectiveness of the repellent related to spectrum of activity against various mosquito species and other arthropods was examined as well as longevity of applied dose. Where possible, efficacy was compared to deet as being the accepted gold standard. All sections employed MEDLINE via PubMed in literature searches augmented by others depending on the subject area investigated. Details of the review process can be found at http://www.istm.org; click on “ISTM Committees” and then “Publications.” ### Major Findings N , N ‐diethyl‐3‐methylbenzamide (deet), (2‐(2‐hydroxyethyl)‐piperidinecarboxylic acid 1‐methyl ester (icaridin), p ‐methane 3, 8‐diol (PMD), and ethyl butylacetylaminopropionate (IR3535)‐based repellents all provide protection against biting arthropods, but volatile oils and other natural products are less reliable. On the strength of available evidence, the first‐line choice for those visiting areas where …

Medical Supplies for Travelers to Developing Countries

BACKGROUND There has been little research to date on the use of medicines and first aid supplies by travelers. In some developing countries such products may be difficult to obtain, and there is the danger that substandard medicines may be purchased. As space for medical supplies in the luggage of many individuals, particularly backpackers, may be restricted, it is important to identify correctly those items most likely to be needed. OBJECTIVES The aim of this study was to survey a cohort of travelers from the UK visiting a variety of destinations in developing countries, regarding the medical supplies taken and used during their trip. METHOD Travelers visiting a specialist travel pharmacy in London, UK were recruited consecutively into the study. Only those planning to visit destinations in South America, Asia, Africa or the Middle East for < or = 2 weeks and returning to the UK were included. Participants were handed a questionnaire to be posted back when they returned to the UK, asking them to note those items that they included in the kit, those actually used, and any others obtained while they were away. All subjects had consulted the pharmacist concerning the medical kit appropriate for their trip. RESULTS Two hundred and ninety-nine travelers volunteered to take part, of whom 127 returned the postal questionnaire. Analgesics and medication for the treatment of diarrhea were most likely to be used, but many types of wound dressing were unlikely to be required. Twenty individuals (16%) required antibiotics, with eight people purchasing them while they were away. Thirty-two (31%) individuals did not use insect repellents despite traveling to potentially malaria-endemic countries. Only seven subjects purchased any other items while they were away. CONCLUSION The items most likely to be required by travelers to developing countries are analgesics, treatments for diarrhea, antiseptics and sticking plasters. The provision of antibiotics to certain travelers is probably justified.

Mosquito repellents for the traveller: does picaridin provide longer protection than DEET?

Background This review examines the published laboratory and field tests where the repellents DEET and picaridin have been compared for their efficacy as repellents against mosquitoes. The review is limited to an assessment of whether the duration of protection afforded by picaridin is similar to or better than DEET. Method Identification and analysis of laboratory and field-based trials published in peer-reviewed journals that compared DEET to picaridin efficacy. Results Only eight field studies and three laboratory studies met the review criteria for inclusion and most were considered to be of high risk of bias and of lower quality when judged against evidence-based principles. Overall, the studies showed little potential difference between DEET and picaridin applied at the same dosage, with some evidence pointing to a superior persistence for picaridin. Conclusion Applied dosage is one important variable in determining the persistence of a repellent experienced by users but the maximum concentration in current picaridin formulation is <30%w/v. Therefore, where only 30% DEET or lower concentrations are available, then on current evidence, it is reasonable to offer DEET or picaridin as a first choice. Where >50% DEET products are available then the protection time advantage associated with these formulations reasonably can be invoked to consider them as first choice repellents.

The Provision of Prescription-Only Medicines for Use on UK-based Overseas Expeditions

Expedition teams without accompanying medical professionals traveling overseas from the UK frequently carry medical kits containing prescription-only medicines (POMs). Access to safe, basic POMs whilst on expedition is important, as the quality and availability of medicines in-country may not be acceptable, and delay in treatment may be hazardous. At present, there is no published guidance relating to drug acquisition and administration in these situations. In the UK, a number of different practices are currently in use, with uncertainty and medicolegal concerns currently hampering safe and efficient provision of POMs on overseas expeditions. A guideline is proposed for the management of prescription-only medications in an expedition setting.