Guidelines for the prevention of malaria in travellers from the United Kingdom. PHLS Malaria Reference Laboratory, London School of Hygiene and Tropical Medicine.

These guidelines on malaria prevention are an aid to health care workers who advise travellers, particularly those who will be overseas for less than a year. They represent a virtual consensus of the views of 44 doctors, nurses, and pharmacists with special expertise in malariology or travel medicine who met to develop them in 1996 (see list on R152). The guidelines are in three parts. The first part is a summary that emphasises modifications to the advice given in the last set of guidelines, published in 1995. The second part discusses the issues addressed in formulating the guidelines. Doctors, practice nurses, and pharmacists are asked to read this section to avoid doing harm by giving chemoprophylaxis without due attention to the traveller's history or destination and by using oversimplified lists of recommendations by country. The second part also addresses the health care worker's consultation with prospective travellers. The third part gives specific recommendations for travellers to specific destinations and some details of individual drugs. Fuller information on some points was given in earlier versions of the guidelines, which should not be discarded. Meetings of the sort described above have been held since 1980 and the group's membership has included people with varied views and experience. The views expressed in these guidelines reflect experienced professional opinion, since data are inadequate for unequivocal views to be given on several issues. There is often a range of acceptable options, but to meet the requests of general practitioners the guidelines try to give one recommended option and state alternatives, suggesting when and how different regimens can be used to good effect. Decisions on the terms under which different drugs are licensed for use are the responsibility of the Licensing Authority, advised by the Committee on Safety of Medicines (not of these guidelines). The guidelines should be read as a supplement to and not as a substitute for the relevant data sheets. Chemoprophylaxis lies somewhere between vaccination (for which people expect governments to lay down schedules) and treatment of ill people (for which each physician does what seems most appropriate) in concept and practice. The risks of malaria need to be balanced against the risks of the preventive measures, on the basis of the data available. Travellers may ask for an explanation of these risks and doctors and practice nurses need to be well informed and able to present their knowledge to travellers. The second part of these guidelines may be of use to prospective travellers who wish to read about the options themselves. All readers are recommended to read part two in its entirety to get a balanced picture.