What are the Centers for Disease Control and Prevention (CDC) recommendations for antimalarial medication and prevention if traveling to Panama, which has a malaria risk?

CDC Recommendations for Malaria Prevention When Traveling to Panama

For travelers to Panama, the CDC recommends using atovaquone-proguanil as the first-line malaria prophylaxis, along with personal protective measures to prevent mosquito bites. 1

Malaria Risk in Panama

Panama has documented chloroquine-resistant Plasmodium falciparum malaria 2. It was the first country in Central America to officially discard chloroquine as a first-line treatment for P. falciparum cases due to evidence of parasite resistance to chloroquine and antifolate drugs.

Recommended Antimalarial Medications

Based on the most recent guidelines, the following options are recommended:

1. Atovaquone-proguanil (First choice):

   • Start 1-2 days before travel
   • Continue daily during travel
   • Continue for 7 days after leaving Panama 1

2. Alternative options (if atovaquone-proguanil is contraindicated):

   • Mefloquine: Weekly dosing, starting 1-2 weeks before travel, continuing weekly during travel, and for 4 weeks after leaving Panama
   • Doxycycline: Daily dosing, starting 1-2 days before travel, continuing daily during travel and for 4 weeks after leaving Panama 1

Essential Personal Protective Measures

In addition to medication, the CDC strongly recommends these protective measures:

• Use DEET-containing insect repellent on all exposed skin
• Wear long-sleeved clothing (ideally treated with permethrin)
• Sleep under permethrin-treated mosquito nets
• Stay in well-screened or air-conditioned areas, especially between dusk and dawn when Anopheles mosquitoes are most active 3, 1

Special Considerations

For Pregnant Women

• Avoid travel to Panama if possible
• If travel is necessary, chloroquine and proguanil have a long history of safe use during pregnancy 1
• Mefloquine can be used in second and third trimesters
• Doxycycline and primaquine are contraindicated during pregnancy 3

For Children

• Children ≥15 kg: Same medications as adults with adjusted dosing
• Children <15 kg: Chloroquine (mefloquine is contraindicated) 1
• Doxycycline is contraindicated in children under 8 years of age 3, 1

Post-Travel Vigilance

• Continue prophylaxis for the recommended duration after leaving Panama (7 days for atovaquone-proguanil, 4 weeks for other medications)
• Seek immediate medical attention if fever develops within 3 months of return
• Inform healthcare providers about travel history to Panama 1

Important Cautions

• No prophylaxis regimen is 100% effective
• Malaria symptoms can develop as early as 8 days after exposure or as late as several months after return
• In the US, approximately 71.7% of residents diagnosed with malaria had not taken proper chemoprophylaxis during travel 4
• Store antimalarial medications in child-proof containers out of children's reach, as overdose can be fatal 3