What are the current guidelines for malaria prophylaxis in travellers to endemic regions?

Current guidelines for malaria prophylaxis in travelers to endemic regions recommend a tailored approach based on the destination's malaria species prevalence, resistance patterns, duration of travel, and individual patient factors such as age, pregnancy status, and comorbidities ¹. First-line prophylactic agents typically include atovaquone-proguanil, doxycycline, and mefloquine, with the choice influenced by regional resistance and patient tolerance ¹. Atovaquone-proguanil is preferred for short trips and in areas with chloroquine-resistant Plasmodium falciparum, while doxycycline is an alternative for longer stays but requires daily dosing and sun protection advice ¹. Mefloquine is reserved for areas with known sensitivity but is contraindicated in patients with certain neuropsychiatric conditions ¹.

Additional measures include starting prophylaxis 1-2 days before entering the endemic area (for atovaquone-proguanil) or 1-2 weeks prior (for mefloquine), continuing during the stay, and for 7 days (atovaquone-proguanil, doxycycline) or 4 weeks (mefloquine) after leaving the area ¹. Non-pharmacological prevention such as insect bite avoidance using repellents, bed nets, and appropriate clothing is strongly emphasized ¹.

Recent literature from French guidelines and reviews supports these recommendations but highlights the importance of updated regional resistance data and the potential role of newer agents or combination strategies in specific populations, including children and pregnant women (Leblanc et al., 2020; Delaigue et al., 2020). They also stress the need for individualized risk assessment and patient education to improve adherence and effectiveness (Gerstenlauer, 2019).