Preventing malaria

In this video, you will learn about the most common prophylactic medications used to avert malaria.

John F. Fisher, MD MACP FIDSA
John F. Fisher, MD MACP FIDSA
26th Jun 2020 • 3m read

Contrary to common belief, prophylactic drugs don't actually prevent malaria—they simply treat the malaria that people travelling to endemic areas are almost certainly going to contract. In this video, from our Malaria Mini: The Basics course, we take a look at the common prophylactic medications used, and the critical factors you need to consider, before prescribing these drugs to your travelling patients.

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Video transcript

Now that we know how to treat malaria, is it possible to prevent it in the first place? Anyone who has traveled to an area with endemic malaria knows how important it is to take their anti malarial prophylaxis. Because the mosquitoes in these areas are so prevalent, it's almost a guarantee that travelers will end up contracting malaria.

So these prophylactic medications generally don't actually prevent a person from being infected with malaria. But instead they are treating the malaria that the traveler is almost certain to contract. No anti malarial drug is 100% protective and must be combined with the use of personal protective measures, such as insect repellent, long sleeves, long pants, sleeping in a mosquito free setting, or using an insecticide treated bed nets.

The combination of Atovaquone and Proguanil is usually given once a day as prevention for falciparum malaria. However, it is important to know that some falciparum malaria are resistant to Atovaquone. So this may not be the ideal combination for individuals traveling to certain areas. The combination cannot be used by women who are pregnant or breastfeeding a child less than five kilograms.

Some people would rather take medicine weekly. Chloroquine is a good choice for long trips, because it is taken only weakly. The drug can be used in all trimesters of pregnancy. However, it cannot be used in areas with Chloroquine or mefloquine resistance. Doxycycline, which is taken daily, tends to be the least expensive anti malarial.

It is also good for last minute travelers because the drug has started one to two days before traveling to an area where malaria transmission occurs. Persons planning on considerable sun exposure, they want to avoid the increased risk of Sun sensitivity with doxycycline. The drug cannot be used by pregnant women and children less than eight years of age. Mefloquine is another weekly medication, it can be taken in pregnancy.

However, it has been associated with rare but serious adverse reactions such as psychosis or seizures, and prophylactic doses. primaquine is one of the most effective medicines for preventing plasmodium buybacks. And so it is a good choice for traveled to places with more than 90% Plasmodium vivax infections.

It needs to be taken daily and cannot be used in patients with glucose six phosphatase dehydrogenase, G six PD deficiency or in patients who have not been tested for the deficiency primaquine cannot be used by pregnant women or in women who are breastfeeding unless the infant has also been tested for G six PD deficiency. So what about vaccines?

How far along are we? Well, it makes sense that we're trying to develop vaccines against the sporozoites because if you had a vaccine, which prevented the sporozoite from being injected by a mosquito in the first place, or prevented those from reaching the liver, you could prevent the transmission of malaria.

Most current research is focused on anti sporozoite vaccines were attenuated not dead sporozoites are injected to try to prevent the initial infection of liver cells by the parasites. These are promising but all still in experimental stages.

So hope you liked this video. Absolutely. Make sure to check out the course this video was taken from and to register for a free trial account which will give you access to select the chapters of the course. If you want to learn how Medmastery can help you become a great clinician, make sure to watch the about Medmastery video. So thanks for watching, and I hope to see you again soon. Bye.