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prophylaxis for malaria

Management: avoid mosquito bites - wear protective clothing - use insect repellant (DEET) - stay in screened areas from dusk til dawn - sleep with bed netting, preferably permethrin-treated chemoprophylaxis - endemic areas with chloroquine-resistant P falciparum - mefloquine - 250mg tablet weekly - start 2 1/2 weeks before travel, continue for 4 weeks after return - resistance seen in Thailand bordering with Burma & Cambodia - ok for pregnant women in 2nd or 3rd trimester [1] - however, women should be advised to delay travel until after delivery if possible [1] - Malarone (atovaquone 250mg & proguanil 100mg) - areas of mefloquine resistance - 1 tab QD - start 2 days before travel, continue for 1 week after return - doxycycline - areas of mefloquine resistance - 100 mg QD - start 2 days before travel, continue for 4 weeks after return - endemic areas with chloroquine-sensitive P falciparum - chloroquine (Nivaquine or Avloclor) - 500 mg weekly - start one week before travel, continue for four weeks after return - Mexico, Central America, Bolivia, Egypt, Saudi Arabia, Carribean (Haiti, Dominican Republic) [2], Middle East bordering Mediterranean Sea [3] - hydroxychloroquine (Nivaquine or Avloclor) - 500 mg weekly - start one week before travel, continue for four weeks after return - primaquine - 26.3 mg QD - start 1-2 days before travel, continue for 1 week after return - mefloquine, Malarone, doxycycline (alternatives, schedule as above) - endemic areas with P vivax - primaquine - 52.6 mg QD - start 1-2 days before travel, continue for 1 week after return - chloroquine, hydroxychloroquine, mefloquine, Malarone, doxycycline (alternatives, schedule as above) - take antimalarials preferably with or after a meal - check with CDC regarding resistance patterns with different areas of travel [4] - among Ethiopian children - monthly sulfadoxine-pyrimethamine + amodiaquine for seasonal malaria chemoprevention [4] - addition of azithromycin does not reduce mortality or hospital admission [4] - monoclonal antibody CIS43LS provides prophylaxis vs Plasmodium falciparum over a 6-month malaria season - P falciparum infection detected in 18% who received a 40-mg/kg dose of CIS43LS vs 78% who received placebo - CIS43LS targets the P falciparum circumsporozoite protein expressed on the surface of sporozoites, the parasite stage transmitted by mosquitoes to humans

Related

malaria

General

antibiotic prophylaxis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17. American College of Physicians, Philadelphia 2006, 2012, 2015
  2. Schlagenhauf P, Petersen E. Malaria chemoprophylaxis: strategies for risk groups. Clin Microbiol Rev. 2008 Jul;21(3):466-72 PMID: 18625682
  3. Freedman DO Clinical practice. Malaria prevention in short-term travelers. N Engl J Med. 2008 Aug 7;359(6):603-12 PMID: 18687641
  4. Chandramohan D et al Effect of Adding Azithromycin to Seasonal Malaria Chemoprevention. N Engl J Med 2019; 380:2197-2206. June 6, 2019 PMID: 30699301 Free full text https://www.nejm.org/doi/full/10.1056/NEJMoa1811400 - Keenan JD et al Longer-Term Assessment of Azithromycin for Reducing Childhood Mortality in Africa. N Engl J Med 2019; 380:2207-2214. June 6, 2019 PMID: 31167050 https://www.nejm.org/doi/full/10.1056/NEJMoa1817213 Bar-Zeev N et al Hope and Humility for Azithromycin. N Engl J Med 2019; 380:2264-2265. June 6, 2019 PMID: 31167057 https://www.nejm.org/doi/full/10.1056/NEJMe1906459
  5. Hein I Monoclonal Antibody Shows Protection Against Malaria. But is intravenous administration going to get in the way? MedPage Today October 31, 2022 https://www.medpagetoday.com/meetingcoverage/astmh/101512
  6. Centers for Disease Control: Malaria prevention http://www.cdc.gov/malaria/control_prevention/prevention.htm
  7. The Travel Doctor: Malaria Information Page http://www.traveldoctor.co.uk/malaria.htm