Steffen R, Behrens R H
Division of Epidemiology and Prevention of Communicable Diseases, Institute of Social and Preventive Medicine of the University, Sumatrostrcsse 30, CH-8006 Zürich, Switzerland .
Parasitol Today. 1992 Feb;8(2):61-6. doi: 10.1016/0169-4758(92)90091-f.
The risk of malaria poses travellers and their advisers with difficult problems as drug resistance spreads worldwide. Protection against infection rests on travellers' knowledge of the risk of malaria, on their avoidance of malaria vectors and on their compliant use of chemoprophylaxis. In this article, Robert Ste f fen and Ronald Behrens explain that one of the priorities for reducing malaria morbidity is to improve travellers' use of personal protection against mosquito bites. They show that none of the drugs, or combinations thereof, provide a 100% efficacy, owing to increasing drug resistance, mainly of Plasmodium falciparum. The commonly used drugs for malaria prophylaxis (mefloquine, doxycycline, chloroquine and proguanil) often cause minor side effects. All, except proguanil, have also been occasionally associated with severe adverse effects. Other drugs (pyrimethaminelsul fadoxine, amodioquine) are not suitable for chemoprophylaxis because of unacceptable adverse reactions. The use of drugs for self therapy is constrained by limitations of toxicity and efficacy, and the added difficulties of defining indications for safe and appropriate use.
随着耐药性在全球范围内蔓延，疟疾风险给旅行者及其顾问带来了难题。预防感染取决于旅行者对疟疾风险的了解、对疟疾病媒的避免以及对化学预防药物的依从使用。在本文中，罗伯特·斯特芬和罗纳德·贝伦斯解释说，降低疟疾发病率的首要任务之一是提高旅行者对个人防蚊叮咬保护措施的使用。他们指出，由于耐药性增加，主要是恶性疟原虫的耐药性增加，没有一种药物或其组合能提供100%的疗效。常用的疟疾预防药物（甲氟喹、多西环素、氯喹和氯胍）常常会引起轻微副作用。除氯胍外，所有这些药物偶尔也会与严重不良反应有关。其他药物（乙胺嘧啶/磺胺多辛、阿莫地喹）由于不良反应不可接受而不适合用于化学预防。自我治疗药物的使用受到毒性和疗效限制以及确定安全和适当使用指征的额外困难的制约。
