A 19-year-old college student comes to the office prior to a trip to India with concern for travel-related infections. He has no prior medical problems and is up to date with basic immunizations. Physical examination is normal. The patient is advised to consume bottled water and avoid raw foods. Hepatitis A and typhoid vaccinations and prescriptions for traveler's diarrhea are provided. Which of the following is the most effective measure for preventing malaria in this patient?

Question

A 19-year-old college student comes to the office prior to a trip to India with concern for travel-related infections.  He has no prior medical problems and is up to date with basic immunizations.  Physical examination is normal.  The patient is advised to consume bottled water and avoid raw foods.  Hepatitis A and typhoid vaccinations and prescriptions for traveler's diarrhea are provided.  Which of the following is the most effective measure for preventing malaria in this patient?

Quizplus · Accepted Answer

The effective prevention of malaria relies on a thorough understanding of endemic strains, antimicrobial resistance, and relative risk of infection. Travelers new to an endemic region or those returning after a long absence are at high risk of clinical illness and require chemoprophylaxis. India is a malaria endemic country with a high prevalence of both Plasmodium falciparum and P vivax. Chloroquine resistance is common; therefore, travelers are usually given chemoprophylaxis with atovaquone-proguanil, doxycycline, or mefloquine. Mefloquine treatment should begin >2 weeks prior to travel, continued during the stay, and discontinued 4 weeks after returning. Neuropsychiatric side effects (eg, anxiety, depression, restlessness) occur in approximately 5% of patients and should prompt a change to an alternate medication. Chloroquine resistance > In addition to chemoprophylaxis, travelers are advised to prevent mosquito bites with protective clothing, insect repellent, and insecticide-treated bed netting. (Choices A and B) Chloroquine chemoprophylaxis is used only in areas without resistance (eg, parts of Central America, Caribbean). Resistance is widespread in Africa, Asia (including India), and Oceania. Primaquine is administered to patients with P vivax malaria to eliminate dormant hepatic hypnozoites; it can be used for chemoprophylaxis only in areas that have >90% P vivax. (Choices D, E, and F) Mosquito bite prevention (eg, insecticide, insecticide-treated bed nets) alone is indicated for travelers to areas that have sporadic cases of malaria (eg, Belize). Because India is a malaria endemic country, chemoprophylaxis, in addition to mosquito bite prevention, is recommended. Educational objective: Malaria chemoprophylaxis is recommended for most travelers who visit malaria endemic countries. In areas with high rates of chloroquine resistance, patients typically receive atovaquone-proguanil, doxycycline, or mefloquine. Measures for avoiding mosquito bites (eg, protective clothing, insecticide, insecticide-treated bed nets) are also recommended. References: Prevention of malaria in travelers. (http://www.ncbi.nlm.nih.gov/pubmed/22612048)

A 19-Year-Old College Student Comes to the Office Prior to a Trip