Connor uses an algorithm based on the antimalarial sensitivity in a region to help guide malarial prophylaxis in travelers. The author is from the New York Center for Travel and Tropical Medicine in New York City.


(1) Determine if the traveler requires prophylaxis.

(2) Determine regimen based on sensitivity in region.

(3) Look for contraindications to help select candidate agent(s).

(4) Troubleshoot the patient who requires prophylaxis but who cannot take recommended drug.


Step 1: Is the risk of malaria sufficient to warrant prophylaxis? If no, then none given.


Step 2: If risk is sufficient to warrant prophylaxis, determine regimen.


Malaria in Region

Drug Factor

Regimen Choices

chloroquine sensitive

able to take chloroquine


chloroquine sensitive

unable to take chloroquine due to intolerance or contraindication

mefloquine, or

doxycycline, or


chloroquine resistant


mefloquine, or

doxycycline, or


mefloquine resistant


doxycycline, or



Step 3: Determine if drug cannot be used because of contraindication.



Major Contraindications


hepatic insufficiency


seizure disorder, cardiac conduction disturbance, history of depression or mental illness


sun exposure (phototoxicity), pediatric patient, pregnancy, hepatic insufficiency, renal insufficiency, possibly yeast infection


renal insufficiency, uncertain for use in pregnancy



• According to the Sanford Guide to Antimicrobial Therapy (page 120 in 1999 edition), doxycycline can be used in pediatric patients >= 8 years of age.


Step 4: If none of the recommended drugs can be taken, then

(a) Consider change in travel plans to eliminate malaria risk. For example, delay in travel until after delivery in a pregnant woman, reduced sun exposure if doxycycline selected.

(b) Determine if anti-mosquito measures alone is sufficient protection.

(c) Refer the patient to an expert.

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