NEWER ANTI-MALARIALS

PRESCRIPTION DRUGS FOR MALARIA: 
All travelers to areas of the world where malaria is present should use 
the appropriate drug regimen and personal protection measures to prevent 
malaria. We will advise as to which form(s) of malaria are present in 
your areas of travel and which medications and doses are correct for 
you.

PREVENTION: 
Drugs Used In Chloroquine-Resistant Areas:

MEFLOQUINE: The adult dosage is 250 mg (one tablet) once a week. 
MEFLOQUINE should be taken one week before leaving, weekly while in the 
malarious area, and weekly for 4 weeks after leaving the malarious area.

Minor side effects while taking MEFLOQUINE include gastrointestinal 
disturbances and dizziness, which tend to be mild and temporary. More
serious side effects at the recommended dosage have rarely occurred.

MEFLOQUINE should NOT be used by travelers with a history of epilepsy or 
psychiatric disorder, or travelers with a known hypersensitivity to 
mefloquine. In consultation with a physician, mefloquine may be used by 
pregnant women and children less than 30 pounds, when travel to an area 
with chloroquine-resistant malaria is unavoidable.

DOXYCYCLINE - Travelers who CANNOT TAKE MEFLOQUINE should take
DOXYCYCLINE to prevent malaria if they are traveling in a malarious 
area. This drug is taken every day at an adult dose of 100 mg, to begin 
on the day before entering the malarious area, while there, and 
continued for 4 weeks after leaving. If DOXYCYCLINE is used, there is no 
need to take other preventive drugs, such as CHLOROQUINE. Possible side 
effects include skin photosensitivity that may result in an exaggerated 
sunburn reaction. This risk can be minimized by wearing a hat and using 
sunblock. Women who take DOXYCYCLINE may develop vaginal yeast 
infections.

DOXYCYCLINE should NOT be used by pregnant women during the entire 
pregnancy, children under 8 years of age or travelers with a known 
hypersensitivity to doxycycline or tetracycline.

CHLOROQUINE & PROGUANIL - CHLOROQUINE is used to prevent malaria for 
travelers who cannot take MEFLOQUINE or DOXYCYCLINE. CHLOROQUINE is 
often marketed in the United States under the brand name Aralen . The 
adult dosage is 500 mg (salt) once a week. This drug should be taken one 
week before entering a malarious area, weekly while there, and weekly 
for 4 weeks after leaving the malarious area. Travelers to sub-Saharan
Africa who use CHLOROQUINE should, if possible, also consider taking 
simultaneously, PROGUANIL. The adult dose of PROGUANIL is 200 mg/day. 
PROGUANIL is not available in the United States, but can be purchased in 
Canada, Europe, and many African countries.

Rare side effects to CHLOROQUINE include upset stomach, headache, 
dizziness, blurred vision, and itching. Generally these effects do not 
require the drug to be discontinued.

Drugs Used In Chloroquine-Sensitive Areas:

CHLOROQUINE - CHLOROQUINE alone is used to prevent malaria for travelers 
going to specific geographical regions such as North Africa, the 
Caribbean, Temperate South America, most of Central America, and part of 
the Middle East. In these regions CHLOROQUINE is still effective in 
preventing malaria.

SUMMARY OF PRESCRIPTION DRUGS FOR MALARIA: 
MEFLOQUINE (LARIAM) - Used in areas where Chloroquine-resistant malaria 
has been reported.

DOXYCYCLINE - Used as an alternative to Mefloquine.

CHLOROQUINE (ARALEN)- Used in areas where Chloroquine-resistant malaria 
has not been reported.

PROGUANIL (PALUDRINE)- Used simultaneously WITH Chloroquine as an 
alternative to Mefloquine or Doxycycline. Proguanil is NOT available in 
the United States.

ADULTS: 200 mg, orally once a day , in combination with weekly 
Chloroquine.

CHILDREN: The following dosages are to be taken in combination with
weekly Chloroquine: < 2 years old, 50 mg per day; 2-6 years old, 100 mg
per day; 7-10 years old: 150 mg per day; and > 10 years old: 200 mg per
day.

DRUGS USED FOR TEMPORARY SELF-TREATMENT:
FANSIDAR - CHLOROQUINE may not prevent malaria (in areas where there is
CHLOROQUINE-resistant malaria), and travelers who use CHLOROQUINE must 
take additional measures. In addition to stringent personal protection 
measures, you should also take with you one or more treatment doses of 
FANSIDAR . NO ONE WITH A HISTORY OF SULFA ALLERGY SHOULD TAKE FANSIDAR. 
Each treatment dose for an adult consists of 3 tablets, taken as a 
single dose to treat any fever during the travel if professional medical 
care is not available within 24 hours. This is only a temporary measure; 
you should seek medical care as soon as possible. You should continue 
taking the weekly dose of CHLOROQUINE after treatment with Fansidar.

PREVENTING MOSQUITO BITES: 

In addition to using drugs to prevent malaria, travelers should use
measures to reduce exposure to malaria-carrying mosquitoes, which bite
during the evening and night. To reduce mosquito bites you should remain
in well-screened areas, use mosquito nets, and wear clothes that cover
most of the body.

You should also take insect repellent with you to use on any exposed 
areas of the skin. The most effective repellent is DEET (N,N-diethyl 
meta-toluamide) an ingredient in most insect repellents. DEET-containing 
insect repellents should always be used according to label directions 
and sparingly on children. Adults should use 30-35% DEET on exposed 
areas of the skin. Avoid applying higher-concentration (greater than 
35%) products to the skin. Pediatric insect repellents with 6-10% DEET 
are available. Rarely toxic reactions or other problems have developed 
after contact with DEET.

You should also purchase a flying insect-killing spray to use in living 
and sleeping areas during the evening and night. For greater protection, 
clothing and bednets can be soaked in or sprayed with PERMETHRIN, which 
is an insect repellent licensed for use on clothing. If applied 
according to the directions, permethrin will repel insects from clothing 
for several weeks. Portable mosquito bednets, DEET containing 
repellents, and permethrin can be purchased in hardware, back-packing, 
or military surplus stores.