[Malaria chemoprophylaxis. Resistance problems]

Abstract

Several drugs are used for malaria chemoprophylaxis: 4 amino-quinolines, antifolics, combinations of sulfonamides and antifolics, and new anti-malarial agents, including mefloquine. The indications and contra-indications of their use are reviewed with respect to their tolerance and pharmacokinetics. Severe side effects associated with the administration of sulfonamide + pyrimethamine are discussed. The development of Plasmodium falciparum resistance to chloroquine and other agents creates a new challenge for chemoprophylaxis. The choice of chemoprophylaxis is dictated by the geographical incidence of resistance: in low risk areas (no chloroquine resistance), 4-amino-quinolines should be used because of the good tolerance; in medium risk areas (low frequency of resistant strains), amodiaquine is useful for prophylaxis and presumptive treatment of fevers is indicated; in high risk areas (high incidence of resistant strains), no anti-malarial agent but the newly developed mefloquine is effective.