Education is the most important factor
in preventing malaria among travelers. If you're planning
a trip to a malarious area, you must understand the
necessity of (1) taking preventive medications and (2)
using personal protective measures to prevent mosquito
In many areas of the world malaria is
now resistant to ARALEN ®
(chloroquine). These areas are frequently referred to
as CRFM (chloroquine-resistant falciparum malaria).
LARIAM ® (mefloquine)
is the drug of choice to prevent malaria in chloroquine-resistant
areas, but travelers with a history of epilepsy, psychiatric
disorders, or cardiac conduction abnormalities should
not use mefloquine. MALARONE ®
is a new antimalarial medication recently approved by
the FDA and available in September 2000. Carefully check
the Medications section
of this site for doses, precautions, indications, and
side effects of these medications.
Chloroquine remains the drug of choice
in the Dominican Republic, Haiti, Central America west
of Panama, Egypt, and most countries in the Middle East.
Travelers to sub-Saharan Africa who cannot take mefloquine
and who use chloroquine should, if possible, also consider
simultaneous use with proguanil (only available abroad).
MALARONE ® is the other choice for travelers unable to
use mefloquine or doxycycline. As with many diseases,
however, there is no guaranteed protection against contracting
malaria, despite the fact that you take preventive medication.
It is always wise to combine the proper anti-malarial
medicine with the correct use of insect repellents and
other personal protective measures.
Mefloquine and chloroquine are both taken
once weekly and should be started 1 week before entering
a malarious area and continued for 4 weeks after leaving
the area. Doxycycline is taken daily and should be started
1 day before entering a malarious area and continued
for 4 weeks after leaving the area. MALARONE ® is taken
daily starting 1- 2 days before entering a malarious
area, daily while in the malarious area, and continued
daily for 7 days after leaving the area.
In your travels, don't be surprised to
meet other travelers using different medications than
those you are taking. Never share their medication without
expert consultation; however, if you are going to reside
in an area for an extended period of time, consider
following local medical advice regarding malaria medication
after 1 month. Travel experts from many countries cannot
agree on the best medications to prevent malaria, and
the recommendations change frequently.
The prevention of malaria in children,
pregnant women, and breastfeeding women are special
conditions that require careful medical guidance. Malaria
can be more serious in pregnant patients and increase
the risk of maternal death, abortion, stillbirth, and
low birth weight. At the time of this writing (January,
2001), mefloquine and chloroquine are the only approved
preventive medications in the USA for pregnant travelers.
According to WHO, mefloquine should only be used during
the 2nd and 3rd trimesters. mefloquine should only be
used during pregnancy when travel to chloroquine-resistant
areas is unavoidable. Doxycycline and MALARONE ® should
never be used during pregnancy.
Because most of the world is now resistant
to chloroquine, pregnant women should not travel to
malarious areas unless it is absolutely essential. Medications
used to prevent malaria are passed in breast milk. They
are not sufficient to prevent malaria and do not appear
to harm the infant. The infant must always take his
or her own preventive medication.
Chloroquine is not effective for children
in most of the malaria endemic areas of the world, although
it's approved as a preventive medication for children
of any age. Chloroquine is not available in the USA
in suspension form except when mixed by a pharmacist
according to the weight of the child. According to the
CDC, in consultation with a physician, mefloquine may
be used in children under 30 pounds when travel to a
chloroquine-resistant area is unavoidable. WHO does
not recommend using mefloquine in infants under 5 kg
or younger than 3 months. Children under the age of
8 years should not use doxycycline. MALARONE ® should
not be used in children under 10 lbs. Overdosage
of antimalarials can be fatal, and these drugs should
be stored in childproof containers out of the reach
of children. For more information on malaria medications,
including doses, side effects, contraindications and
precautions, see Medications.
for a comprehensive review of LARIAM ® mefloquine.
Because the drugs used for malaria prevention
are far from ideal, personal protective measures to
avoid being bitten are just as important. These measures
must be clearly understood and used correctly.
Health Information for International Travel 2000-2001,
DHHS, Atlanta, GA, 2001; WHO,
International Travel and Health, 2002, Geneva;
and Dr. Richard Thompson's book
Well on the Road - A
Practical Guide for the International Traveler, 2002.