Travelers to areas where malaria occurs should discuss their travel plans
with a physician well before departure. Drugs to prevent malaria are usually
prescribed for travelers to malarious areas. Travelers from different
countries may receive different recommendations, reflecting differences
in approach and availability of medicines in different countries. Travelers
visiting only cities or rural areas where there is no risk of malaria
may not require preventive drugs; an exact itinerary is necessary to decide
the degree of protection required.
Strict adherence to the recommended doses and schedules of the antimalarial
drug selected is necessary for effective protection.
Take tablets on the same day each week or, in the case of tablets to
be taken daily, at the same time each day.
Take tablets after meals.
Take the recommended doses 1 to 2 weeks before travel, throughout the
trip, and for 4 weeks after leaving the malarious area.
Don't stop taking the tablets after arriving home; it is essential to
complete the full dosage.
Choosing antimalarial drugs has become complicated by the appearance
of drug-resistant strains of malaria. In Mexico, Central America, Haiti,
the Dominican Republic, the Middle East, the preventive drug of choice
is weekly Chloroquine. In all other malarious areas the drug of choice
is weekly Mefloquine (Lariam). If Mefloquine cannot be taken, an effective
alternative is daily Doxycycline or Malarone. If neither Mefloquine, Malarone
nor Doxycycline can be taken, Chloroquine (with or without Proguanil a
drug not available in the United States) is a third alternative; unfortunately,
this drug combination is much less effective in most areas. If Chloroquine
is used in drug-resistant areas, a suitable stand-by treatment should
be carried in case malarial symptoms occur and medical help cannot be
obtained within 24 hours.
All medicines have some side effects; however, if a serious side effect
occurs, the traveler should seek medical help and discontinue taking the
antimalarial drug. Mild nausea, occasional vomiting, or loose stools are
not adequate reasons for stopping the antimalarial drug. The seriousness
of malaria warrants tolerating temporary side effects.
MALARONE is a combination of atovaquone (250mg) and proguanil (100mg)
used for the prevention and treatment of malaria. The adult dose for prophylaxis
is 250 mg atovaquone/ 100 mg proguanil (1 adult tablet) orally once daily.
For children who weigh more than 11 kg, doses vary by body weight. This
drug should be taken 1-2 days before travel, daily while there, and continued
daily for 1 week after departure from the malarious area. Side effects
of MALARONE tend to be uncommon and include abdominal pain, nausea vomiting
and headache. Due to lack of data this drug is not currently recommended
in pregnant women, in women breastfeeding infants or in infants who weigh
less than 11 kg.
This drug is marketed in the United States under the name Lariam. The
adult dose is 250 mg (one tablet) once a week. Children are dosed based
on weight. MEFLOQUINE should be taken one to two weeks prior to departure,
weekly during travel and taken for four weeks after leaving malaria endemic
Minor side effects one may experience while taking MEFLOQUINE include
gastrointestinal disturbances and dizziness, which tend to be mild and
temporary. More serious side effects at the recommended dosage have rarely
occurred. MEFLOQUINE is contraindicated in patients with a known hypersensitivity
to MEFLOQUIINE or related compounds (e.g., quinine and quinidine). MEFLOQUINE
should not be prescribed for prophylaxis in patients with active depression,
a recent history of depression, generalized anxiety disorder, psychosis,
or schizophrenia or other major psychiatric disorders, cardiac conduction
abnormalities or with a history of convulsions. In consultation with a
physician, pregnant women and children less than 30 pounds may use MEFLOQUINE,
when travel to an area with Chloroquine-resistant malaria is unavoidable.
Travelers who cannot take MEFLOQUINE, CHLOROQUINE or MALARONE should
take DOXYCYCLINE to prevent malaria if they are traveling in a malarious
area. This drug is taken every day at an adult dose of 100 mg, to begin
on the day before entering the malarious area, while there, and continued
for 4 weeks after leaving. If DOXYCYCLINE is used, there is no need to
take other preventive drugs, such as CHLOROQUINE.
Possible side effects include skin photosensitivity that may result in
an exaggerated sunburn reaction. Wearing a hat and using sunblock can
minimize this risk. Women who take DOXYCYCLINE may develop vaginal yeast
infections and should discuss this with their doctor before using DOXYCYCLINE.
Pregnant women during their entire pregnancy should not use DOXYCYCLINE.
Children under 8 years of age or travelers with a known hypersensitivity
to DOXYCYCLINE should not take this medication.
CHLOROQUINE is used to prevent malaria for travelers who cannot take
MEFLOQUINE , MALARONE or DOXYCYCLINE. CHLOROQUINE is often marketed in
the United States under the brand name Aralen. The adult dosage is 500
mg (salt) once a week. This drug should be taken one week before entering
a malarious area, weekly while there, and weekly for 4 weeks after leaving
the malarious area. Travelers to sub-Saharan Africa who use CHLOROQUINE
should, if possible, also consider taking simultaneously, PROGUANIL. The
adult dose of PROGUANIL is 200 mg/day. PROGUANIL is not available in the
United States, but can be purchased in Canada, Europe, and many African
Rare side effects to CHLOROQUINE include upset stomach, headache, dizziness,
blurred vision, and itching. Generally these effects do not require the
drug to be discontinued.
CHLOROQUINE may not prevent malaria (in areas where there is CHLOROQUINE
resistant malaria) and travelers who use CHLOROQUINE must take additional
measures. In addition to stringent personal protection measures, they
should also take with them one or more treatment doses of FANSIDAR. Each
treatment dose for an adult consists of 3 tablets. These 3 tablets should
be taken as a single dose to treat any fever during the travel if professional
medical care is not available within 24 hours. Such presumptive self-treatment
of a possible malaria infection is only a temporary measure; the traveler
should seek medical care as soon as possible. Travelers should continue
taking the weekly dose of CHLOROQUINE after treatment with FANSIDAR.
In certain cases, where there has been extended exposure to vivax malaria
and only CHLOROQUINE has been used and/ or malaria prophylaxis was prematurely
discontinued, PRIMAQUINE may be used to eliminate the possibility of a
delayed malaria attack. The usual adult dose is 15 mg-30mg base daily
for 14 days. PRIMAQUINE is contraindicated during pregnancy.