[Exceptions to malaria chemoprophylaxis for the traveller]

With the increasing development of international travel, the administration of malaria chemoprophylaxis has become very common; however, the pertinence of this prescription may in many cases be questioned. All the available drugs, particularly the more recent ones, for preventing chloroquine-resistant Plasmodium falciparum malaria, can induce adverse effects. Thus, it is better to avoid chemoprophylaxis when not absolutely necessary. It should be remembered that in many tropical and subtropical countries malaria does not occur at all and in others, the level of transmission is insignificant or low. On the other hand, in the regions with a high rate of transmission, lack of chemoprophylaxis can be justified only by extremely brief, repeated exposures (e.g. aircrew). When travelling without chemoprophylaxis to an area with malarial transmission, even at minimal level, one must (i) use rigorous antivectorial prophylaxis, (ii) call immediately to mind the diagnosis of malaria in the case of unexpected febrile illness, and (iii) be in possession of a stand-by treatment if there is no access to emergency advice.