The malaria threat.
The British experience of the past two decades indicates that fixed-schedule chemoprophylaxis is difficult because of the variety of epidemiological situations and increasing incidence of drug resistance. Of the 110 cases of malaria contracted in Kenya between 1982 and 1996, 74% were due to Plasmodium falciparum. Of the 45 malaria infections contracted in Belize, 84% were due to Plasmodium vivax. In 1985 the fixed drug combination of chloroquine base 300 mg weekly plus proguanil 200 mg daily was adopted as standard chemoprophylaxis for use in all parts of the world where chemoresistant Plasmodium falciparum had been observed. Mefloquine was recommended as first-line prophylaxis in Papua New Guinea in 1986 and in East Africa in 1993. Doxycycline hyclate was prescribed in September 1999 when a Gurkha company was deployed on peacekeeping duties to East Timor, but its effectiveness has not yet been evaluated. Chemoprophylaxis must be combined with non-drug antimalaria technologies, especially insecticide-treated bed nets.
Croft
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AM
Surgeon General's Department, Ministry of Defence, Whitehall, London SW1A 2HB, UK. AshleyCroft@compuserve.com
Geary
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KG
D000962:Antimalarials / Q000627:therapeutic use*; D002738:Chloroquine / Q000627:therapeutic use; D004318:Doxycycline / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004351:Drug Resistance; D006291:Health Policy; D006801:Humans; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000517:prevention & control; D016780:Malaria, Vivax / Q000453:epidemiology / Q000517:prevention & control; D015767:Mefloquine / Q000627:therapeutic use; D008889:Military Personnel; D002727:Proguanil / Q000627:therapeutic use
D000962:Antimalarials; D002738:Chloroquine; D004318:Doxycycline; D002727:Proguanil; D015767:Mefloquine