The Italian army standpoint on malaria chemoprophylaxis

Soldiers on duty in tropical areas are at high risk of malaria and need chemoprophylactic regimens which may ensure the best efficacy, tolerability and compliance. Current Italian Army guidelines are based on recent military experiences in tropical areas, where mefloquine prophylaxis was as well tolerated as combination treatment with chloroquine and proguanil but more effective and easier to comply with, at least among soldiers. Chloroquine alone (300 mg base once/week) is prescribed for areas without chloroquine-resistant Plasmodium falciparum, while mefloquine (250 mg once/week) is recommended for areas with chloroquine-resistance. Doxycycline is the first choice regimen for mefloquine-resistant areas and an alternative to mefloquine when this medication is contraindicated or not tolerated. The combination chloroquine-proguanil represents the alternative chemoprophylactic regimen when mefloquine and doxycycline are contraindicated or not tolerated.