Long-term malaria prophylaxis for travelers.

Long-term malaria prophylaxis is hampered by a lack of standardization and compliance. Advice should be individually optimized to achieve a high degree of protection and compliance. Individual risk assessment takes into consideration the duration of stay in the endemic area, the individual exposure, the seasonal transmission rates, and the drug-resistance situation.Methods for prevention of exposure may help reduce the reliance on chemoprophylactic drugs.Exposure-prevention methods may be combined with standby treatment in lower transmission areas if the traveler has been trained to take the antimalarials appropriately. Although suitable for longterm use, chloroquine and chloroquine-proguanil cannot be used as prophylaxis owing to high resistance rates in most endemic regions. Mefloquine is suitable for most malaria-endemic regions,although its use is restricted by neuropsychiatric side effects, particularly in women. Doxycycline is also appropriate; experience with longterm malaria prophylaxis is available for up to 6 months. The use of atovaquone-proguanil is restricted to 28 days in some countries,but clinical studies indicate that its use is suitable for at least 20 weeks.Primaquine is also effective for chemoprophylaxis; experience is limited to 1 year of protection against falciparum and vivax malaria.When giving individual recommendations to a traveler, special considerations for backpackers, expatriates, and frequent travelers may apply.