Malaria chemoprophylaxis for multiple drug resistant Plasmodium falciparum in Africa: an increasing problem

Resistance of P. falciparum to the two groups of antimalaria drugs commonly used for prophylaxis, i.e. folate antagonists and 4-aminoquinolines has become a matter of great concern, also in Africa. After 1978, P. falciparum developed resistance to the group of 4-aminoquinolines, which was first reported from East Africa. Chloroquine resistant infections are now spreading into Central Africa. Similar developments are now appearing with the combination sulfadoxine/pyrimethamine. With the increasing reports of multiple drug resistance in P. falciparum from Africa, no single drug or combination of drugs in use for chemoprophylaxis can give a complete protection under all circumstances any longer. Until new effective drugs become available, it is advised to use the combination of chloroquine or amodiaquine and proguanil; the traveller should be prepared for action in the event of a breakthrough. A written instruction is suggested to be inserted in the "International Certificate of Vaccination".