Chemoprophylaxis for malaria

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May be used for special risk group or Children and short time travellers but discouraged.

Bangladesh is a multi-drug resistant area for Falciparum Malaria. Chloroquine, SP have very high failure rates. Quinine and Artemisinine derivatives are not suitable for prophylaxis.

So, recommendations are:

❖ To use personal preventive measures (bed net, mosquito repellents, protective wears etc.)

❖ All febrile episodes (up to 4 weeks following visit) should be investigated for malaria by RDT/ BSE and treatment with ACT if positive. If cannot be tested for Malaria, should be treated with ACT on suspicion.

❖ Mefloquine (250mg weekly for adult) may be used: to be started 2 weeks before and 4 weeks following visit.

Rationale for use/not to use of other drugs available in the market:

Chloroquine: Treatment Failure rate is high, so it should not be used in falciparum cases.

Sulphadoxine+Pyremethamine (Fansidar): Failure rate is high.

Quinine Monotherapy: Effective but not recommended

Metloquine Monotherapy: Effective but not recommended

Artesunate Monotherapy: Effective but not recommended

**Monotherapy is less effective and leads to early development of resistance and not recommended.