| CHLOROQUINE |
Chloroquine
alone is used to prevent malaria for travelers going to specific
geographical regions such as North Africa, the Caribbean, Temperate
South America, and part of the Middle East. The adult dosage
is 500 mg once weekly. The drug should be taken one week before
entering a malarious area, weekly while there, and weekly for
4 weeks after leaving a malarious area.
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.
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| CHLOROQUINE-RESISTANT
AREAS |
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| MEFLOQUINE |
250mg
of mefloquine once a week should be taken one week before entering
an endemic area, weekly while in the malarious area, and once
a week for 4 weeks after leaving the malarious area.
Minor side effects may be experienced such as gastrointestinal
disturbances and dizziness, which tend to be mild and temporary.
More serious side effects at the recommended dosage have rarely
occurred.
Mefloquine cannot be recommended in travelers with a history
of epilepsy or psychiatric disorder, known hypersensitivity
to mefloquine or having cardiac conduction abnormalities.
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| DOXYCYCLINE |
Travelers
unable to take mefloquine should take doxycycline to prevent
malaria while travelling to a malarious area. Doxycycline is
to be taken every day at an adult dose of 100 mg, beginning
on the day of entry into the malarious area, while there, and
to be continued for 4 weeks after leaving. While using doxycycline
there is no need to use other preventive drugs including chloroquine.
Possible side effects include skin photosensitivity that may
result in an exaggerated sunburn reaction. Using protections
such as wearing a hat, sunblock can minimize this . Women on
doxycycline may develop vaginal candidiasis and thus they should
discuss this with their doctor before using the drug. Gastrointestinal
symptoms (nausea and vomiting) seen in 3-7 % of the users.
Doxycycline cannot be used by pregnant women, Children under
8 years of age or by travelers with a known hypersensitivity
to doxycycline.
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| PROGUANIL |
| 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. |
| EMERGENCY
STAND-BY MEDICATION |
| Travelers
to areas with a very low risk of infection should carry a stand-by
medication instead of using chemoprophylaxis. The rationale
for such a strategy is that in such areas the risk of adverse
events may well exceed the benefits of avoided infection. Travelers
with stand-by medication are instructed that, should malaria
symptoms occur, they should first seek medical care. The stand-by
medication can be used by the local doctor, or for self-medication
if no medical care can be obtained within 12-24 hours after
the onset of the illness. Persons using mefloquine or doxycycline
for prophylaxis do not need to carry stand-by medication. Only
persons not using chemoprophylaxis or using chloroquine with
or without proguanil in areas with chloroquine-resistant P.falciparum
should carry medication with them. Among the drugs recommended
as stand-by medication, Pyrimethamine-Sulfadoxine appears to
be effective outside South-east Asia and South America, and
it is well tolerated when used for treatment. |
| PYRIMETHAMINE-SULFADOXINE |
| In addition
to stringent personal protection measures, travelers to areas
with low risk of infection should take with them one or more
treatment dose of pyrimethamine-sulfadoxine. Each treatment
dose (adult) consists of 3 tablets to be taken as a single dose
to treat any fever during the travel if professional medical
help is not available within 24 hours. Such presumptive treatment
of a possible malaria infection is only a temporary measure
; the traveler should take medical help as soon as possible.
Traveler should continue taking the weekly dose of chloroquine
after treatment with pyrimethamine-sulfadoxine.
Pyrimethamine-sulfadoxine should NOT be used by persons who
have history of sulfa allergy. |
| ANTI-MOSQUITO
MEASURES |
- Contact with mosquitoes can be reduced by remaining in
well screened areas, using mosquito nets and wearing clothes
that cover most of the body
- Protective effect of the clothing can be enhanced by impregnating
or spraying it with a repellant or an insecticide.
- Topical repellants with diethyltoluamide (DEET) are effective,
but they need to be applied every 2-3 hours
- Concentration of DEET should be between 25-30 %. Higher
concentration should be avoided in infants and children
- Insecticides and coils are effective; in non-air-conditioned
and inadequately screened rooms the mosquito net is an effective
tool.
- Impregnation with permethrin increases the usefulness
of the nets.
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