Prevention

Malaria is largely preventable through use of personal protective measures and appropriate chemoprophylaxis. A recent study confirmed that travelers to malarious areas frequently do not use antimosquito measures or take antimalarial drugs.12 Between dusk and dawn, travelers should remain in well-screened areas, use mosquito nets if needed, and wear long-sleeved clothing. A pyrethrum-containing insect spray should be used during evening hours and before retiring to bed. Permethrin can be sprayed on clothing for additional protection, and an insect repellent containing W,M-diethyl-m-toluamide (DEET) applied to exposed skin.

Appropriate chemoprophylaxis depends on where one will be traveling. If potential exposure to infected mosquitoes is likely, prophylaxis is warranted even if such exposure will be brief. Table 142:6 summarizes the chemotherapeutic agents of choice.2413 The Centers for Disease Control and Prevention maintains a 24-h malaria hotline (888-232-3228), which provides up-to-date information on resistance patterns in countries. Chemoprophylaxis should generally be taken for 4 weeks following the last exposure. Studies exploring other chemoprophylactic options, such as proguanil combined with atovaquone or dapsone 1 14 and monotherapy with daily azithromycin,15 appear promising.

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