Malaria: current prophylaxis options

Abstract

Most South African travellers visiting sub-Saharan countries to the north will require protection against malaria. This should include personal protection measures (PPM) and chemoprophylaxis. PPM include: DEET based insect repellent, clothing (preferably impregnated with permethrin) that minimises skin exposure, bed nets, screening and use of knock down and residual application insecticides in rooms. Reliance on PPM alone will be insufficient for most malarious destinations. Currently available chemoprophylactic drugs in general use in South Africa are mefloquine, doxycycline, and atovaquone-proguanil. All three are highly efficacious, but attention must be given to drug contraindications when prescribing for an individual traveller. No prophylactic regimen is 100% effective, and all travellers who develop a fever or an influenza-like illness within six months of return should seek urgent medical attention and be tested for malaria.