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TM: Travel Medicine (iii) Malaria prevention (Bite avoidance (avoid being…
TM: Travel Medicine (iii) Malaria prevention
Bite avoidance
avoid being outdoors between dusk + dawn
cover up as much as possible
use repellent on exposed areas
avoid dark clothing + perfumes
DEET txed clothing
use screens on doors + windows
spray room regularly with proprietary fly spray
mosquito net: tuck in properly, repair tears, txed nets are best (permethrin)
check surroundings for stagnant water
ABCD
awareness
bite avoidance
chemoprophylaxis
dx of febrile illness
intro
50% of deaths in West Africa
Natural immunity wanes after 6 months - 2yrs (NB VFR)
hazardous in pregnancy
bad outcomes: cerebral malaria
evidence that blood group A is less appealing to mosquitos
chemoprophylaxis
chloroquine + proguanil
not v effective anymore, only India
SEs: mouth ulcers, abdo discomfort, hair loss, itching
safe in 1st trimester
good for expats
mefloquine (Larium)
don't give if hx of depression - screen for hx of psych/neuro/cardiac conduction disorders
related to quinine
highly effective
adverse reactions
25% mild headache, GI upset, malaise
1/250 - 1/500: nightmares, irritability, depression, anxiety
1/1000: seizures, psychosis
trial dosing recommended before travel
only option with pregnancy
doxycycline
long acting tetracycline
goog efficacy in chloroquine resistant P falciparum
90+% effective in Africa
only effective agent in parts on Asia
SEs: photosensitivity (sunburn), nausea, vomiting, diarrhoea, oesophagi's, overgrowth infections (e.g. candidiasis), pseudomembranous colitis
contraindicated in children + pregnancy
Atovaquone + proguanil (malarone)
tafenoquine