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How to give up-to-date advice on malaria prevention

By Professor David Bradley and Dr Barbara Bannister on behalf of the Advisory Committee on Malaria Prevention

Pharmacists frequently provide information on malaria prophylaxis but recent reports in the media have suggested that pharmacists’ advice on malaria prophylaxis is not always up to date. This article highlights new guidelines for the prevention of malaria in travellers which are to be published next week in the journal Communicable Disease and Public Health (2001;4:84). The guidelines provide the most comprehensive and up-to-date recommendations for advising travellers on malaria prophylaxis.

Next week, we will publish extracts from the detailed recommendations plus comprehensive tables on prophylaxis.

Advising travellers

A consultation on malaria with an intending traveller should ascertain the degree of risk, emphasise the need for protection against mosquito bites, advise the need for seeking immediate medical attention in the event of a febrile illness within three months (or even a year) of leaving the malarious area, and recommend chemoprophylaxis appropriate to the risk and destination(s). Health care workers should avoid giving unnecessary medication and be aware of contraindications.

The level and duration of risk depends upon destination, duration, activities to be undertaken, and style of travel. The choice of drug will depend on previous history, pregnancy, relevant family history, and concomitant illness or medication. In deciding on the preferable chemoprophylactic regimen for a particular traveller, the following variables need to be assessed:

  • Countries and places to be visited and their malaria risk. This may vary during the year and according to whether the destination is rural or urban.
  • Type of accommodation to be used.
  • Duration of intended stay in malarious areas.
  • Intended activities (eg, beach/jungle explorations/safaris), particularly between dusk and dawn, when the risk of being bitten is present.
  • Style of travel (eg, business/backpacking/package-tour/visiting relations).
  • Age, sex, pregnancy, intended conception, and breast feeding.
  • Weight of young children — which is a better guide than age to the dose of antimalarials.
  • Previous travel and experience with antimalarials.
  • Previous reactions to antimalarials.
  • Current illnesses (renal and hepatic function, cardiac conduction, myasthenia gravis, psoriasis, fits, psychiatric disorders).
  • Personal or family history of epilepsy in first degree relatives.
  • History of psychiatric disorder, depression, anxiety requiring treatment.
  • Current medication (anticoagulants, anticonvulsants, cimetidine, cyclosporin, cardiac glycosides, cytotoxic drugs, antibacterials, probenecid).

Travellers undertaking different types of travel and activities in the same country may be exposed to a different range of risk, depending on the degree of exposure to anopheline mosquito bites between dusk and dawn. The risk of acquiring malaria is always substantial for tourists in tropical Africa.

Visiting friends and relations

Malaria attack rates are particularly high among those who travel to malarious areas, for example, Asia, to visit friends and relations. Many such travellers are former immigrants who settled in the United Kingdom long ago. They might have left Asia during the malaria eradication era (1955 to 1969), when risk there was low, or they may believe that they have some persistent immunity. Such immunity fades rapidly, but compliance with prophylaxis in some of these groups is poorer than in other travellers. These travellers are often accompanied by their children, who may be at greater risk than adults of severe illness if they contract malaria. It is therefore particularly important to emphasise compliance with chemoprophylaxis. Risk is very high in West Africa and many of the comments for backpackers apply to all visitors to this area.

Download the attached PDF to read the full article.

Citation: The Pharmaceutical Journal URI: 10977807

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