Trends and controversies in the prophylaxis and treatment of malaria

Several areas of clinical concern and investigation have emerged over the past year in the malaria field. Mefloquine prophylaxis has required a change in its dosing regimen. Continued monitoring for potential mefloquine toxicity has shown this agent to be safe for use for many populations, but not routinely for pregnant women or for young children. Chloroquine-resistant Plasmodium vixax may be geographically limited currently, but its presence in Irian Jaya has serious implications, should be problem spread. The currently available fluoroquinolone antibiotics possess antimalarial activity but they have not proven to be clinically dependable for the treatment of resistant Plasmodium falciparum infections. However, continued investigation of both their mechanisms of action and efficacy should not be abandoned. Adjunctive measures for the control of mosquito vectors and the prevention of human contact with mosquitoes assume greater importance as both pharmacological prophylaxis and therapy for malaria infections become increasingly difficult. Health professionals who advise travelers to endemic regions should emphasize the use of safe topical repellents and residual insecticides, which can be impregnated into bed netting and clothing.