From the Guidelines
For travelers to Punta Cana, Dominican Republic, malaria prevention is generally not required as the risk is very low in this tourist area. The Dominican Republic has limited malaria transmission, primarily in areas bordering Haiti and some rural western provinces, but Punta Cana is considered a low-risk zone.
Key Prevention Measures
Instead of antimalarial medication, focus on mosquito bite prevention measures including:
- Using insect repellent containing 20-30% DEET or 20% picaridin on exposed skin 1
- Wearing long sleeves and pants when outdoors (especially during evening and night)
- Sleeping in air-conditioned or screened rooms
- Using permethrin-treated clothing and gear If you plan to travel beyond Punta Cana to western areas of the country or near the Haitian border, consult a travel medicine specialist about possible antimalarial medication.
Rationale
These recommendations focus on mosquito avoidance because Anopheles mosquitoes, which transmit malaria, primarily bite between dusk and dawn, and preventing bites is the most effective strategy in low-risk areas like Punta Cana 1. It is essential to note that no prophylaxis is infallible, so all fever and flu-like illnesses occurring within a year of returning from malarious regions need to be urgently investigated with malaria in mind 1.
From the FDA Drug Label
For the prophylaxis of malaria: For adults, the recommended dose is 100 mg daily. For children over 8 years of age, the recommended dose is 2 mg/kg given once daily up to the adult dose. Prophylaxis should begin 1 to 2 days before travel to the malarious area. Prophylaxis should be continued daily during travel in the malarious area and for 4 weeks after the traveler leaves the malarious area Malaria Prophylaxis in Adults Dosage: One 250 mg mefloquine hydrochloride tablet once weekly. Prophylactic drug administration should begin 1 week before arrival in an endemic area. Subsequent weekly doses should be taken regularly, always on the same day of each week, preferably after the main meal
- Malaria Prevention:
- Punta Cana: Since Punta Cana is a malarious area, malaria prophylaxis is recommended.
- Key Considerations:
From the Research
Malaria Prevention for Punta Cana
Overview of Malaria Prevention
Malaria is a significant concern for travelers to endemic areas, including Punta Cana. Several antimalarial drugs are available for prevention, including atovaquone-proguanil, mefloquine, and doxycycline.
Atovaquone-Proguanil
- Atovaquone-proguanil is a highly effective antimalarial drug for the prevention of Plasmodium falciparum malaria 4.
- It is a fixed-dose combination tablet that provides causal and suppressive prophylaxis 4.
- Atovaquone-proguanil is generally well tolerated, with fewer gastrointestinal and neuropsychiatric adverse events compared to other antimalarial drugs 4, 5.
Mefloquine
- Mefloquine is another antimalarial drug commonly used for prevention, but it has been associated with neuropsychiatric adverse events 6.
- Mefloquine users are more likely to experience abnormal dreams, insomnia, anxiety, and depressed mood compared to atovaquone-proguanil users 6.
- Mefloquine is still considered effective for malaria prevention, but its use should be balanced against the potential for adverse events 6.
Comparison of Antimalarial Drugs
- Atovaquone-proguanil and doxycycline are considered the best-tolerated regimens for malaria prevention 5.
- Mefloquine is associated with a higher risk of neuropsychiatric adverse events compared to atovaquone-proguanil and doxycycline 5, 6.
- The choice of antimalarial drug depends on individual factors, including the risk of malaria, the potential for adverse events, and personal preference 6.
Treatment of Uncomplicated Malaria
- Atovaquone-proguanil is also effective for the treatment of uncomplicated Plasmodium falciparum malaria 7.
- The addition of artesunate to atovaquone-proguanil may reduce treatment failure rates 7.
- Atovaquone-proguanil is generally well tolerated, with no strong associations with specific adverse events 7.