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 type 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.
- Don’t stop taking the tablets after arriving home; it is essential
to complete the full course.
Choosing antimalarial drugs has become complicated by the appearance of
drug-resistant strains of malaria. In areas of the world where drug resistance
has NOT occurred CHLOROQUINE taken weekly is the drug of choice. In all
other areas of the malarious world, which are drug-resistant to CHLOROQUINE,
the drug of choice is daily MALARONE. If MALARONE cannot be taken, an
effective alternative is daily Doxycycline. If neither MALARONE nor DOXYCYCLINE
can be taken, MEFLOQUINE, taken weekly, can be prescribed.
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 and proguanil 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. This drug should
be taken 1-2 days before travel, daily while in the malarious area, 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.
Travelers who cannot take or do not want to take MALARONE or MEFLOQUINE
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 gastrointestinal disturbances and skin
photosensitivity that may result in an exaggerated sunburn reaction. Wearing
a hat and using sun block 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. Neither should children under 8 years of age
or travelers with a known hypersensitivity to Doxycycline.
This drug is marketed in the United States under the brand name LARIUM.
The adult dosage is 250 mg (one tablet) once a week. MEFLOQUINE should
be taken one week before leaving, weekly while in the malarious area,
and weekly for 4 weeks after departing from the malarious area.
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 but can include neuro-psychiatric effects. Travelers with a history
of a psychiatric disorder or on an anti-depressant or travelers with a
known hypersensitivity to MEFLOQUINE should not use MEFLOQUINE. 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
CHLOROQUINE is often marketed in the United States under the brand name
Aralen. The adult dosage is 500 mg 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. Rare side effects to CHLOROQUINE
include gastrointestinal disturbances, headache, dizziness, blurred vision,
and itching. Generally these effects do not require the drug to be discontinued.
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 (see ‘presumptive self-treatment for
Malaria’ on this page).
PRESUMPTIVE SELF-TREATMENT FOR MALARIA
There may be situations where a traveler must initiate presumptive self-treatment
- A febrile traveler who has elected not to take prophylaxis.
- A febrile traveler who did not choose an optimal prophylaxis regimen.
- A traveler who is taking an effective anti-malarial but will be traveling
to very remote areas.
These travelers may elect to 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 MUST seek medical care as soon as possible.
Travelers should continue taking the weekly dose of CHLOROQUINE after
treatment with Fansidar.