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Immunizations and Antibiotics for Oversea Travel (cont.)

Malaria Prevention

  • Malaria does not have a vaccine. Medication must be taken to protect against infection. Some countries have resistance to one or more of the drugs used to prevent malaria. The CDC has a web site where travelers or their physicians can check on resistance patterns and recommended medication for prevention (http://www.cdc.gov/malaria/travelers/
    country_table/a.html
    ). Each of the drugs also has advantages and disadvantages, and travelers may, when multiple options are available, pick an option that better fits their particular situation. The following table was adapted from the CDC web site for malaria (http://www.cdc.gov/malaria/
    travelers/drugs.html
    ).
Drugs Used for Chemoprophylaxis (Given to Prevent Infection) Against Malaria
Drug Advantages Disadvantages
Atovaquone/Proguanil (Malarone) Good for last-minute travel: Only needs to be started one to two days prior to travel

Good for short trips because it only has to be taken for seven days after returning instead of four weeks

Well tolerated

Pediatric tablets available
Cannot be used in women who are pregnant or breastfeeding

Cannot be used in children less than 5 kg.

Cannot be used for patients with severe renal impairment

Expensive

Must be taken daily
Chloroquine (Aralen Phosphate) Taken once weekly

If patient already on hydroxychloroquine (Plaquenil) for rheumatologic diagnosis, he or she may not need any other medications

Safe during pregnancy
Cannot be used in areas of chloroquine or mefloquine resistance

Can exacerbate psoriasis

Must be taken for four weeks after returning from trip

Must be taken for one to two weeks prior to travel
Doxycycline Good for last-minute travel: Only needs to be started one to two days prior to travel

Least expensive

Patient may already be on it for other conditions and would not have to take an additional medication

Prevents some other diseases that may be encountered on trips (like Rocky Mountain spotted fever)
Cannot be used in women who are pregnant or children less than 8 years of age

Must be taken for four weeks after returning from trip

Sun sensitivity

More frequent stomach upset
Mefloquine (Lariam) Taken once weekly

Safe during pregnancy
Cannot be used in areas with mefloquine resistance

Lot of drug interactions

Must be taken two weeks prior to travel

Must be taken for four weeks after returning from trip
Primaquine Good for last-minute travel: Only needs to be started one to two days prior to travel

Only have to take for seven days after returning from trip
Cannot be used in patients with glucose-6-phosphatase dehydrogenase (G6PD) deficiency and patient must be tested for the deficiency

Cannot be used in pregnancy or if breastfeeding (unless the child has been tested for G6PD)
  • Pediatric dosing for chemoprophylaxis: Infants and children of any age are at risk for contracting malaria and must receive prophylactic antibiotics. None of the medications listed in the table above are available as a liquid. The pills can be pulverized by a pharmacist and placed in gelatin capsules. If the child cannot swallow pills or capsules, then the capsule can be broken open each day and combined with some applesauce, chocolate syrup, or jelly. Give the dose on a full stomach. Exact dosages recommended by the CDC are available at http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/malaria.htm#1939.
  • Everyone in malaria-prone areas should wear DEET insect repellent (for example, Ultrathon) and should seek blood evaluation for possible treatment if symptoms develop. Another newer repellant is Picaridin, which does not smell as strong as the DEET but requires more frequent application. Permethrin-containing repellent (for example, Permanone) can be applied to clothing, shoes, tents, gear, and mosquito nets, but permethrin is not approved for direct application onto skin. There is commercially available clothing that is impregnated with permethrin and will withstand multiple washings while maintaining an effect. Most repellants are safe for children over 2 months of age.




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