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- Recognize that malaria risk and the efficacy of prophylactic regimens vary by geographic region, malaria transmission intensity, and antimalarial drug resistance.
- Prescribe appropriate antimalarial chemoprophylaxis while taking into account anticipated drug resistance patterns, tolerability, and costs.
- Stress the importance of mosquito avoidance and repellent measures in prevention of malaria.
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Recognize that malaria risk and the efficacy of prophylactic regimens vary by geographic region, malaria transmission intensity, and antimalarial drug resistance.  |
- Review the traveler's itinerary, asking about destination, type of trip, season, and duration.
- Consult updated travel medicine resources for the geographic distribution of malaria and drug-resistant parasites.
- Consult a travel clinic specialist in your state for advice, as needed.
- Recommend specific chemoprophylaxis and mosquito avoidance measures.
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Prescribe appropriate antimalarial chemoprophylaxis while taking into account anticipated drug resistance patterns, tolerability, and costs.  |
- Use chloroquine in travelers to areas where chloroquine-resistant P. falciparum has not been reported.
- Use mefloquine in travelers to areas where chloroquine-resistant P. falciparum has been reported, except in areas where mefloquine resistance also has been reported, such as in:
- Thailand
- Myanmar
- Cambodia
- Vietnam
- Use doxycycline or atovaquone-proguanil in travelers:
- To areas where mefloquine-resistant P. falciparum has been reported
- Who are at risk of acquiring chloroquine-resistant malaria but who cannot take mefloquine
- Use atovaquone-proguanil and continue it for 7 days after travel in persons who do not wish to take antimalarials (e.g., doxycycline, mefloquine) for 4 weeks after returning home.
- Check G6PD levels in travelers who will be exposed to P. vivax or P. ovale before travel to determine whether they can receive terminal prophylaxis with primaquine upon their return.
- See table Chemoprophylaxis for Malaria.
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Stress the importance of mosquito avoidance and repellent measures in prevention of malaria. |
- Advise patients to minimize mosquito bites by:
- Appropriately using DEET-containing insect repellents on all exposed skin
- Wearing permethrin-treated clothing
- Wearing clothes that cover as much skin as possible, such as trousers and long-sleeved shirts
- Sleeping under bed nets treated with insecticide every 6 months
- Staying in housing with well-screened areas cleared of mosquitoes
- Refraining from outdoor activity during peak Anopheles biting hours (dusk to dawn)
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| Harry Tagbor, MBChB, DrPH, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Rick M. Fairhurst, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Thomas E. Wellems, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Malaria
