For details on anti-malarial medication dosages and side-effects, including comprehensive protection measures, see IAMAT's publications HOW TO PROTECT YOURSELF AGAINST MALARIA and WORLD MALARIA RISK CHART.

In offering guidance on the choice of anti-malarial drugs, the main concern is to provide protection against P. falciparum malaria. To prevent this fatal form of the disease, chloroquine is the drug of choice where the parasites are still sensitive to it. Chloroquine is also the preferred drug for the suppression of the benign forms of malaria, but it will not always prevent a delayed first attack or relapses due to Plasmodium vivax and Plasmodium ovale.

The appearance of chloroquine resistant and multi-drug resistant P. falciparum in many malarious areas makes the choice of suppressive drugs problematic as none of the medications currently used are 100% effective. Regardless of the medication taken, it is of utmost importance to consider fever and flu-like symptoms appearing seven days up to several months after leaving a malaria area as a malaria breakthrough. Early diagnosis is essential for successful treatment.

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A high incidence of chloroquine-resistant and/or multi-drug resistant Plasmodium falciparum malaria is present in this country. Follow ONE of the following suppressive medication regimens:

1. FOLLOW A LARIAM (MEFLOQUINE HYDROCHLORIDE) REGIMEN: TAKE ONE TABLET OF LARIAM 250mg ONCE A WEEK. START ONE WEEK BEFORE ENTERING THE MALARIOUS AREA, CONTINUE WEEKLY DURING YOUR STAY AND CONTINUE FOR FOUR WEEKS AFTER LEAVING.
   
   (LARIAM should not be taken by persons suffering from cardiac diseases, liver or kidney disorders, epilepsy, psychiatric disorders, pregnant women and children under 30 Ibs/15kg in weight. For description of anti-malarial drugs see IAMAT'S publication HOW TO PROTECT YOURSELF AGAINST MALARIA.)
    
2. FOLLOW A MALARONE (ATOVAQUONE + PROGUANIL) REGIMEN: TAKE ONE TABLET DAILY (250 mg atovaquone + 100 mg proguanil). START 1 TO 2 DAYS BEFORE ENTERING THE MALARIOUS AREA, CONTINUE DAILY DURING YOUR STAY, AND CONTINUE FOR 7 DAYS AFTER LEAVING. MALARONE should be taken at the same time every day with food or milk. See IAMAT's publication HOW TO PROTECT YOURSELF AGAINST MALARIA for description, dosages and contraindications of Malarone.
    
3. FOLLOW A DOXYCYCLINE (VIBRAMYCIN) REGIMEN: TAKE ONE TABLET DAILY OF 100mg DOXYCYCLINE (VIBRAMYCIN). START ONE DAY BEFORE ENTERING MALARIOUS AREA, CONTINUE DAILY DURING YOUR STAY, AND CONTINUE FOR FOUR WEEKS AFTER LEAVING. When taking DOXYCYCLINE avoid exposure to direct sunlight and use sun screen with protection against long range ultraviolet radiation (UVA) to minimize risk of photosensitive reaction. Drink large amounts of water to avoid esophageal and stomach irritation.
   
   DOXYCYCLINE should not be taken by persons with known intolerance to tetracyclines, pregnant women and children under eight years of age. For description of antimalarial drugs refer to IAMAT's publication HOW TO PROTECT YOURSELF AGAINST MALARIA.
    
4. ANTI-MALARIAL REGIMEN FOR PERSONS WHO CANNOT FOLLOW ONE OF THE ABOVE REGIMENS: TAKE CHLOROQUINE (ARALEN) IN WEEKLY DOSES OF 500mg (300mg base). START ONE WEEK BEFORE ENTERING MALARIOUS AREA, CONTINUE WEEKLY DURING YOUR STAY AND CONTINUE FOR FOUR WEEKS AFTER LEAVING. IT IS IMPERATIVE TO USE A MOSQUITO BED NET TO AVOID THE BITE OF THE NOCTURNAL ANOPHELES MOSQUITO. USE REPELLENTS AND INSECTICIDES AS DESCRIBED IN IAMAT'S PUBLICATION HOW TO PROTECT YOURSELF AGAINST MALARIA.
    

In countries with highly chloroquine-resistant P. falciparum malaria, a REGIMEN OF PALUDRINE (proguanil hydrochloride) 200mg DAILY (adult dose) SHOULD BE ADDED TO THE WEEKLY CHLOROQUINE REGIMEN.

PERSONS FOLLOWING A CHLOROQUINE OR A CHLOROQUINE PLUS PROGUANIL HYDROCHLORIDE REGIMEN MUST BE AWARE THAT THESE DRUGS ARE MUCH LESS EFFECTIVE THAN LARIAM, MALARONE OR DOXYCYCLINE. SEEK IMMEDIATE MEDICAL ATTENTION IN CASE OF FLU-LIKE SYMPTOMS - FEVER, HEADACHE, NAUSEA, GENERAL MALAISE - APPEARING ABOUT SEVEN DAYS OR LATER AFTER ENTERING MALARIOUS AREA.

Persons travelling to or working in remote areas where medical attention cannot be sought within 24 hours should consult with a specialist before leaving their home country for advice on a possible self-treatment regimen in case of a malaria breakthrough attack. For description of anti-malarial drugs see IAMAT's publication HOW TO PROTECT YOURSELF AGAINST MALARIA.