Preparing your patients to travel abroad safely. Part 3: Reducing the risk of malaria and dengue fever.

OBJECTIVE To provide evidence-based recommendations for family physicians advising travelers on how to reduce their risk of malaria and dengue fever. QUALITY OF EVIDENCE A search of MEDLINE from 1990 to November 1998 found 671 articles; randomized controlled trials and systematic reviews were sought. The Cochrane Collaboration was searched for studies relevant to family physicians; meta-analyses of impregnating bed nets with permethrin were found. Health Canada's evidence-based publications were searched; 10 recommendations based on at least one well-conducted randomized trial were found. MAIN MESSAGE Good evidence-based advice about the efficacy of mefloquine in chloroquine-resistant areas and for pregnant women and children is available, as is advice on the effectiveness of permethrin-impregnated bed nets. CONCLUSIONS Family physicians can use evidence-based recommendations to advise their patients on how to prevent malaria. The ways in which patients neglect malaria precautions are well-known. For prevention of both malaria and dengue fever, family physicians should counsel their patients to reduce the risk of being bitten by insects.