Academic journal article Bulletin of the World Health Organization

Malaria Chemoprophylactic Regimens for Travellers

Academic journal article Bulletin of the World Health Organization

Malaria Chemoprophylactic Regimens for Travellers

Article excerpt

Country-specific recommendations on chemoprophylactic regimens have been revised by WHO. A summary of these recommendations is outlined below, indicating areas for use and common side-effects of the drugs.

Chloroquine

Chloroquine is recommended for areas where Plasmodium vivax is the predominant species and for areas where P. falciparum is sensitive to chloroquine, including some parts of the Middle East and South America. Chloroquine is administered as weekly prophylaxis at a dose of 300 mg (base).

Chloroquine is usually well tolerated. The few people who do experience uncomfortable side-effects, such as gastrointestinal disturbance, may tolerate it better by taking the drug with meals and in divided twice-weekly doses.

Chloroquine plus proguanil

Chloroquine plus proguanil is the recommended regimen for the following: areas where P. falciparum resistance to chloroquine has been reported, but is of low level, including some areas of South-East Asia and the Middle East; areas where P. falciparum highly resistant to chloroquine occurs, if the traveller cannot tolerate mefloquine or doxycycline; and areas where P. falciparum resistance is present but other drugs are contraindicated because of early pregnancy. This regimen consists of a dose of 300 mg (base) of chloroquine taken weekly plus a dose of 200 mg of proguanil each day.

Chloroquine plus proguanil often causes gastrointestinal upsets. In such an event, taking the drugs with meals, and dividing the chloroquine dosage into twice-weekly doses may reduce the side-effects.

Mefloquine

Mefloquine is recommended for areas where drug-resistant P. falciparum is frequent and/or where high levels of resistance occur including some areas of south-east Asia, Indochina, and Africa. The drug is administered as weekly prophylaxis at a single dose of 250 mg.

Usually, mefloquine is well tolerated in persons with no contraindications. Mild side-effects such as dizziness or gastrointestinal effects may occur transiently during early prophylaxis, but they spontaneously resolve. …

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