Systematic review: Low-quality evidence that atovaquone-proguanil and doxycycline are better tolerated prophylactic antimalarial regimens in travellers than mefloquine

Commentary on:
acquerioz FA, Croft AM . Drugs for preventing malaria in travellers. Cochrane Database Syst Rev 2009:CD006491.
An estimated 10,000–30,000 cases of malaria occur annually in travellers, of which 150 cases are fatal. Prevention strategies include avoidance of the night- biting anopheles mosquito vector, patient education to seek medical attention promptly in case of fever, presumptive selftreatment and drugs to prevent malaria, which was the primary focus of the systematic review by Jacquerioz and Croft. Evolving patterns of drug resistance, exemplified most recently by reports of artemisin resistance in Southeast Asia,1 require periodic review of chemoprophylaxis recommendations for travellers.
 
The scope of this review is the prevention of Plasmodium falciparum, which is the malaria species that causes the overwhelming majority of severe disease and death, and which in many areas of the world is frequently resistant to the classical antimalarial agent chloroquine. This review further focuses on the non-immune traveller without prior malaria exposure, who has a distinct susceptibility profile relative to semi-immune populations living in endemic areas.