Current Drugs for Antimalarial Chemoprophylaxis: A Review of Efficacy and Safety

The resurgence of malaria in areas where it had been controlled previously and the concurrent emergence of drug-resistant malaria strains contribute to the current recommendations concerning malaria chemoprophylaxis. Chloroquine (e.g., Aralen), the former standard for malaria prevention and treatment,is now effective only in limited areas, and multidrug resistance has made chemoprophylaxis with mefloquine (e.g., Lariam) less effective in some regions. This has complicated the decision-making process with regard to selection of optimal antimalarial drug regimens for international travelers. Guidelines from the Centers for Disease Control and Prevention (CDC) provide recommendations for the use of three currently available drugs for malaria prophylaxis in chloroquine-resistant areas: mefloquine, doxycycline (e.g., Vibramycin, Doryx), and atovaquone/proguanil (e.g., Malarone). Guidelines from the World Health Organization (WHO) include the three drugs above, and in addition, consider proguanil (e.g., Paludrine) coadministered or in fixed-dose combination with chloroquine, and also primaquine among current choices for malaria prophylaxis. This article presents a concise review of current knowledge about use of these drug regimens for prophylaxis against malaria. Given the increase in international travel and the spread of malaria into previously disease-free areas,growing numbers of travelers now face the risk of contracting this disease. 1 The number of cases of imported malaria has been rising in the United States,Canada,and other developed countries since the 1970s. In 1997, over 1,500 cases of imported malaria, including 6 fatalities, were reported in the United States, whereas in Canada, 1,036 cases of imported malaria were reported that year. 2‐5 Compounding the problem of increased incidence of malaria,parasite resis