Medical Microbiology

Themainaimofthesemeasuresispreventionofthelife-threateningmalig-

nanttertianmalaria(malariatropica)causedbyP.falciparum.

&Mosquitobiteprevention(preventionofexposure):inviewofwide-

spreaddrugresistanceinplasmodia,itisveryimportanttopreventmosquito

bitesinadditiontochemoprophylacticmeasures.Remember,Anopheles

mosquitoesareactivefromdusktodawnandbitesarepossiblebothout-

sideandinsidebuildings(althoughthisisunusualinair-conditionedrooms).

Ingeneral,theriskofbeingbittenbyanAnophelesmosquitoislowerinurban

Plasmodium 535

Table9. 7 ExamplesofChemoprophylacticRegimensandStandbyMedications

byAreas^1

Area Characteristicsofareas^2 Prophylactic

drugs

Standbydrugs

A Areaswithoutchloroquine

resistanceorwithoutP.falciparum

Chloroquine None

None Chloroquine

B Areaswithchloroquineresistance Chloroquine+

proguanilorme-

floquine

None

None Mefloquine

or

Atovaquone+

proguanil

C Areaswithhighchloroquine

resistanceormultiresistance

Mefloquine

(doxycycline)^3

None

Doxycycline Mefloquineor

atovaquone+

proguanil

Chloroquine+

proguanil

Mefloquineor

atovaquone+

proguanil

(^1) Modifiedandsupplementedaccordingto:InternationalTravelandHealth.Geneva:
WorldHealthOrganization; 2000 andothersources.
Note:Actualupdateswithdetailedinformationoninfectionriskbycountry,region,
andseasoncanbeobtainedfromtheinternet,forexample:www.dtg.mwn.de.
(^2) Thedataonresistancedonotindicatetheactualinfectionrisk.
(^3) IncertainpartsofSoutheastAsia(borderregionCambodia,Myanmar,Thailand).
9
Kayser, Medical Microbiology © 2005 Thieme