Long-Term Malaria Prophylaxis for Travelers

Long-term malaria prophylaxis is hampered by a lack of standardization and compliance. Advice should be individually optimized to achieve a high degree of protection and compliance. Individual risk assessment takes into consideration the duration of stay in the endemic area, the individual exposure, the seasonal transmission rates, and the drug-resistance situation. Methods for prevention of exposure may help reduce the reliance on chemoprophylactic drugs. Exposure-prevention methods may be combined with standby treatment in lower transmission areas if the traveler has been trained to take the antimalarials appropriately. Although suitable for long-term use, chloroquine and chloroquine-proguanil cannot be used as prophylaxis owing to high resistance rates in most endemic regions. Mefloquine is suitable for most malaria-endemic regions, although its use is restricted by neuropsychiatric side effects, particularly in women. Doxycycline is also appropriate; experience with long-term malaria prophylaxis is available for up to 6 months. The use ofatovaquone-proguanil is restricted to 28 days in some countries, but clinical studies indicate that its use is suitable for at least 20 weeks. Primaquine is also effective for chemoprophylaxis; experience is limited to 1 year of protection against falciparum and vivax malaria. When giving individual recommendations to a traveler, special considerations for backpackers, expatriates, and frequent travelers may apply.