Antimalarial drugs such as Chloroquine (Resochine ®), Mefloquine (Lariam ®) or Pyrimethamine/Sulfadoxine (Fansidar ®) are used by travelers either as chemoprophylaxis to prevent malaria infection or as standby-therapy to treat an assumed infection. Both should be seen as addition, not replacement of personal protective measures against mosquito bites!

   Chemoprophylaxis

In choosing an appropriate chemoprophylactic strategy before travel, you and your physician should consider several factors. The travel itinerary should be reviewed in detail and compared with the information on areas of risk to determine whether you will actually be at risk of acquiring malaria. For more info See our health/Malaria map

It should also be determined, whether you will be at risk of acquiring drug-resistant P. falciparum malaria. In addition, it should be established whether you have previously experienced an allergic or other reaction to the antimalarial drug of choice and whether medical care will be readily accessible during your trip.

Malaria chemoprophylaxis should preferably begin 1 - 2 weeks before travel to malarious areas (except for doxycycline, which can begin 1 - 2 days before), which also allows to evaluate and -if necessary- treat any potential side effects of the medication before departure. Chemoprophylaxis should continue during travel in the malarious areas and for 4 weeks after leaving the malarious areas.

Chemoprophylactic regimens:

                    (see also: antimalaria drugs)

Regimen A: For travel to areas of risk where chloroquine-resistant Plasmodium falciparum has not been reported, once-a-week use of chloroquine alone is recommended. Chloroquine (Resochine ®) is usually well tolerated. The few people who experience uncomfortable side effects may tolerate the drug better by taking it with meals or in divided, twice-a-week doses. You should start taking chloroquine 1 - 2 weeks before travel to risky areas; this should be continued weekly during travel and for 4 weeks after you leave malarious regions.

Regimen B: For travel to areas of risk where chloroquine-resistant Plasmodium falciparum exists, use of mefloquine alone is recommended. Mefloquine (Lariam ®) prophylaxis should begin 1 - 2 weeks before travel to malarious areas. It should be continued weekly during travel in malarious areas and for 4 weeks after you leave such areas. Mefloquine can be used for long-term prophylaxis. In some foreign countries a fixed combination of mefloquine and Fansidar ® is marketed under the name Fansimef ®. Fansimef should not be confused with mefloquine, and it is not recommended for prophylaxis of malaria because of the potential for severe adverse reactions associated with prophylactic use of Fansidar.

Because of potentially severe side effects the use of mefloquine for malaria prophylaxis is discussed controversial, among health care professionals as well as among travelers.

Regimen C: For travel to areas of risk where mefloquine-resistant Plasmodium falciparum exists (eg northern Thailand bordering Cambodia, Laos and Myanmar or parts of Kenya) and for travelers for whom regimen B cannot be recommended because of contraindications or severe adverse reactions, 100mg of doxycycline daily is the regimen of choice. Doxycycline prophylaxis should begin 1 - 2 days before travel to malarious areas and should be continued daily during travel in malarious areas and for 4 weeks after leaving such areas.

Note: The combination of chloroquine and proguanil is not routinely recommended as chemoprophylaxis for travelers to areas where chloroquine-resistant Plasmodium falciparum has been reported.

Pyrimethamine/Sulfadoxine (Fansidar®) is a drug for treatment of manifest malaria and should not be used as part of a chemoprophylactic regimen!

Overdose of antimalarial drugs can be fatal. Medication should be stored in childproof containers out of reach of children!

Standby therapy

Stand-by therapy means to take antimalarial medication for self-treatment with you. This medication should be used, when medical care is not available and you suspect malaria infection. Travelers who cannot use mefloquine prophylaxis for medical reasons or travelers who chose to use chloroquine (either alone or with daily proguanil) or no prophylaxis at all, should carry a treatment dose of Fansidar® during travel in areas with risk of chloroquine-resistant P.falciparun malaria. You should take the Fansidar® promptly if you have a febrile illness during your travel and if professional medical care is not available within 24 hours.

However, be aware that this self-treatment of a possible malarial infection is only a temporary measure and that prompt medical evaluation is imperative! Continue your weekly chloroquine prophylaxis after presumptive treatment with Fansidar.

Fansidar dose for stand-by therapy: Adult >50 kg of weight: 3 tablets (= 75 mg pyrimethamine and 1500 mg sulfadoxine), orally as a single dose. Pediatric dose: 1/2 tablet (= 12,5 mg pyrimethamine and 250 mg sulfadoxine) per 10 kg of body weight. Fansidar® is contraindicated for persons with sulfonamide allergy!

Mefloquine should not be used for self-treatment because of the frequency of serious side effects (eg, hallucinations, convulsions) that have been associated with the high dosages of mefloquine used for treatment of malaria. Also Halofantrine (Halfan®) is not recommended for self-treatment of malaria because of potentially serious side effects.