Malaria prophylaxis- is there any adverse effect?
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Hi, my brother's wife Reena is a 35-year-old woman. She is an social activist. She explains that she will be taking a last-minute trip with her husband to South Africa for a 1-week safari. They will leave in 3 days, and she knows they will be traveling to a malaria endemic area and will need medication for prevention. So she is in need of prophylaxis medication. Reena is worried because she heard that one of the medications can cause strange and vivid dreams and is concerned about this potential adverse effect. Can anybody help.
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@Pratibha Malaria is caused by 1 of 4 protozoan species transmitted by the bite of an infected mosquito. The risk of acquiring malaria depends on the region, season, and type of travel. Travelers with a high risk of infection should receive prophylaxis and use mosquito-avoidance measures such as remaining in well-screened areas, using mosquito nets, wearing protective clothing, and using effective insecticide spray.
Six chemoprophylaxis agents are currently available for malaria prophylaxis: atovaquone/ proguanil, chloroquine phosphate, hydroxychloroquine sulfate, doxycycline, mefloquine, and primaquine. All recommended agents involve the patient taking the medication before, during, and after travel to malaria-endemic areas. Each medication comes with its own dosing regimen, duration, and side effects, which should be considered when choosing an agent. The Centers for Disease Control and Prevention has a list of the recommended drugs and the comparable efficacy of each agent in every country (http://phrmcyt.ms/1eUKpYv), which can help in deciding which malaria prevention medication to use. Atovaquone/proguanil (Malarone) is the agent most commonly associated with vivid dreams. Because chloroquine phosphate, hydroxychloroquine sulfate, and mefloquine require treatment to be started at least 1 week prior to arrival in the endemic area. If Reena will not take atovaquone/proguanil because of the potential for vivid dreams, doxycycline or primaquine is the remaining option because prophylaxis with either agent should begin 1 or 2 days before travel to malaria prone areas. Patients who are going to take primaquine should have a documented normal G6PD level before starting the medication. For this reason, doxycycline administered as 1 tablet daily, beginning 1 or 2 days before travel, and continued for 4 weeks after travel may be the best choice.