Long-Term Malaria Prophylaxis for Travelers

Jürgen Knobloch

In This Article

Special Considerations for Backpackers, Expatriates, and Frequent Travelers

Backpackers and other travelers who move from one malarious area to another are not usually familiar with local medical facilities, and they are unable to estimate the laboratory quality of malaria testing. Continuous chemoprophylaxis should therefore be encouraged when indicated. Priority should be given to drugs that may be used for both chemoprophylaxis and standby, such as mefloquine and atovaquone-proguanil.

Expatriates who live where malaria is hyper- or holoendemic should be encouraged to take continuous chemoprophylaxis during the high-transmission periods and to be on standby for the rest of the season. They should rely on local malaria testing and treatment only if there is external quality control of test results.

Travelers who frequently visit malaria-endemic areas should use chemoprophylaxis, standby, or exposure prophylaxis as indicated. If the journey is < 1 week (minimum incubation period of falciparum malaria), continuous malaria chemoprophylaxis is usually not necessary if the traveler returns to a country with high medical standards with regard to diagnosis and treatment of malaria. Some experts, however, always recommend chemoprophylaxis for highly endemic areas regardless of the journey period. If chemoprophylaxis is indicated, priority should be given to drugs that require the minimum period of application such as atovaquone-proguanil rather than mefloquine.