In France, 4,000 imported
malaria cases are reported each year (7,000 to 8,000 estimated).
Chemoprophylaxis is essential for prevention in travelers. When
malaria is susceptible to
chloroquine, this drug (
Nivaquine) has to be used. It is given daily in France (1.5 mg/kg per day), from departure to four weeks after return. When low levels of chloroquino-resistance are reported, French authorities recommend the use of
chloroquine +
proguanil (Savarine) if the
body weight is >50 kg or
Nivaquine) +
Paludrine), if <50 kg), or
atovaquone + proguanil (
Malarone).
Nivaquine) (1.5 mg/kg per day) and
Paludrine) (3 mg/kg per day) have to be pursued for one month after return, although
Malarone) (1 pediatric
tablet/10 kg per day, in children >10 kg weight) may be disrupted after one single week. Adverse events are rarer with
atovaquone + proguanil, than with
chloroquine +
proguanil. When chloroquino-resistance is high,
Malarone) or
mefloquine (
Lariam) are used. Weekly drug regimen is recommended with
mefloquine (5 mg/kg per weight) for the travel duration and four weeks after return and the drug tolerance is good in pediatric prophylaxis.
Doxycycline is used under conditions in children >8 years of age. New drugs as for
tafenoquine, an amino-8 quinoleine, might enhance patients compliance if given monthly.