A 36-year-old man comes to the travel clinic prior to a safari in East Africa. He has a history of intermittent asthma, and he takes albuterol as needed. The patient has no allergies. Physical examination is unremarkable. He inquires about malaria prophylaxis.
Which of the following could be recommended for malaria prophylaxis in this patient?

Question

A 36-year-old man comes to the travel clinic prior to a safari in East Africa.  He has a history of intermittent asthma, and he takes albuterol as needed.  The patient has no allergies.  Physical examination is unremarkable.  He inquires about malaria prophylaxis.
Which of the following could be recommended for malaria prophylaxis in this patient?

Quizplus · Accepted Answer

11ec193a_9858_650e_853d_1916ac5ed073_MD0002_00 Chemoprophylaxis regimens for malaria depend on Plasmodium species (eg, P falciparum versus P vivax or P ovale) and resistance (mostly chloroquine) patterns. These vary by region and can be found on the Centers for Disease Control and Prevention website. There are 3 major antimalarial drug groups: Hepatic schizonticides (atovaquone-proguanil) attack the liver forms of the parasite; hypnozoiticides (primaquine) are active against the quiescent (hypnozoite) liver forms seen with P vivax and P ovale; and blood schizonticides (chloroquine, mefloquine, and doxycycline, as well as atovaquone-proguanil and primaquine) attack the blood forms of the parasite once released from the liver. Atovaquone-proguanil is generally well tolerated and taken daily from 1-2 days before to 7 days after malaria exposure. It is more expensive than doxycycline, which has to be taken for 30 days after returning from a trip with exposure to malaria (as it does not attack the liver forms of the parasite) and can cause photosensitivity and gastrointestinal upset. Mefloquine is taken weekly but is contraindicated with certain neuropsychiatric conditions. Chloroquine can be used in areas without chloroquine-resistant malaria. In regions where P vivax or P ovale are endemic, primaquine provides hypnozoiticide activity (but requires screening for glucose-6-phosphate dehydrogenase deficiency). Pregnant patients should take chloroquine when going to chloroquine-sensitive areas and mefloquine for chloroquine-resistant areas. (Choice B) Ciprofloxacin can be used to treat travelers' diarrhea but has no activity against malaria. (Choice C) Clarithromycin can be used for prophylaxis against Mycobacterium avium complex in patients with HIV who have a CD4 cell count <50/mm³. ³ (Choice D) Mebendazole is an antihelminthic drug used to treat ascariasis, trichuriasis, hookworm, and pinworm infections. (Choice E) Nifurtimox is the antiparasitic drug used to treat some cases of Chagas disease (American trypanosomiasis), which is caused by Trypanosoma cruzi. Educational objective: Chemoprophylaxis regimens for malaria depend on Plasmodium species (eg, P falciparum versus P vivax or P ovale) and resistance (mostly chloroquine) patterns. __________ References: Prevention of malaria in travelers. (http://www.ncbi.nlm.nih.gov/pubmed/22612048)

A 36-Year-Old Man Comes to the Travel Clinic Prior to a Safari