What medications are recommended for travel to a rural area?

Recommended Medications for Travel to Rural Areas

For travel to rural areas where malaria is endemic, mefloquine is the recommended first-line medication for malaria prevention, particularly in regions with chloroquine-resistant Plasmodium falciparum. 1

Malaria Prophylaxis Algorithm

Step 1: Determine Risk Based on Destination

• Chloroquine-sensitive areas: Use chloroquine alone (weekly)
• Chloroquine-resistant areas: Use mefloquine alone (weekly)

Step 2: Assess for Contraindications

• If mefloquine contraindicated (psychiatric disorders, epilepsy, need for fine coordination):
  • Use doxycycline daily (adults and children ≥8 years)
  • Use chloroquine weekly + emergency standby treatment (pregnant women, children <15kg)

Step 3: Timing of Prophylaxis

• Mefloquine: Begin 1-2 weeks before travel
• Chloroquine: Begin 1-2 weeks before travel
• Doxycycline: Begin 1-2 days before travel

Step 4: Dosing Schedule

• Mefloquine: 250mg once weekly for adults 2
• Chloroquine: Weekly dosing
• Doxycycline: Daily dosing

Step 5: Duration After Return

• Continue all prophylaxis for 4 weeks after leaving malarious area
• Exception: Mefloquine requires only two tablets after end of exposure 3

Special Populations

Pregnant Women

• Chloroquine is safe during pregnancy 1
• Avoid mefloquine and doxycycline during pregnancy 1

Children

• Children ≥15kg: Same options as adults with adjusted dosing
• Children <15kg: Chloroquine recommended (mefloquine contraindicated)
• Children <8 years: Avoid doxycycline 1

Additional Protection Measures

Mosquito Avoidance

• Use DEET-containing insect repellent on exposed skin
• Sleep under mosquito nets
• Wear clothing that covers most of the body
• Use pyrethrum-containing flying-insect spray in living/sleeping areas 3
• Apply permethrin (Permanone) to clothing 3

Common Pitfalls to Avoid

1. Failure to match prophylaxis to resistance patterns: Verify current resistance patterns in destination area
2. Inadequate duration of prophylaxis: Continue for recommended duration after return
3. Self-treatment errors: Never use mefloquine for self-treatment due to side effects, especially dizziness 3
4. Overlooking G6PD testing: Required before prescribing primaquine to prevent potentially fatal hemolysis 1
5. Poor compliance: Weekly regimens like mefloquine may improve compliance compared to daily regimens (22% non-compliance with mefloquine vs. 35% with daily proguanil) 4

Post-Exposure Considerations

For travelers to areas with P. vivax or P. ovale, consider primaquine during the last 2 weeks of prophylaxis to prevent relapses that can occur up to 4 years after exposure 3, 1. G6PD testing is mandatory before primaquine administration.

Remember that despite proper prophylaxis, malaria may still be contracted. Travelers should seek immediate medical attention if they develop fever or flu-like symptoms during or after travel to malarious areas.