Lobel H O, Kozarsky P E
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
JAMA. 1997 Dec 3;278(21):1767-71.
Individuals from industrialized nations frequently travel to countries with malaria, so health care providers need to be familiar with current recommendations for prevention of malaria. Changes in drug susceptibility of malaria parasites and evolving knowledge of how well drugs are tolerated necessitate periodic review of guidelines for prophylaxis of malaria, especially of chloroquine-resistant Plasmodium falciparum malaria. Mefloquine is the drug of choice for chemoprophylaxis for most travelers, with doxycycline and chloroquine being less effective alternatives. Mefloquine is well tolerated at prophylactic dosages, but anecdotal reports have raised concerns about its adverse effects. Resistance to this drug has emerged in parts of Southeast Asia and may spread to other regions of the world. The major disadvantages of doxycycline are the need for daily dosing, its contraindication for young children and pregnant women, and its adverse effects. Chloroquine is effective for prophylaxis only in Central America, the Caribbean, and parts of the Middle East. Few new drugs will be available in the near future because of reduced funding for antimalarial drug research and development; therefore, the usefulness of currently available drugs needs to be prolonged by rational use. Increased efforts should be made to ensure that alternative drugs will be available for prevention of malaria.
工业化国家的人们经常前往有疟疾的国家，因此医疗保健人员需要熟悉当前预防疟疾的建议。疟原虫的药物敏感性变化以及对药物耐受性的不断了解，使得有必要定期审查疟疾预防指南，尤其是耐氯喹恶性疟的预防指南。对于大多数旅行者来说，甲氟喹是化学预防的首选药物，强力霉素和氯喹是效果较差的替代药物。甲氟喹在预防剂量下耐受性良好，但轶事报道引发了对其不良反应的担忧。东南亚部分地区已出现对该药物的耐药性，且可能蔓延至世界其他地区。强力霉素的主要缺点是需要每日给药、禁用于幼儿和孕妇以及有不良反应。氯喹仅在中美洲、加勒比地区和中东部分地区对预防有效。由于抗疟药物研发资金减少，近期几乎不会有新药问世；因此，需要合理使用现有药物来延长其效用。应加大力度确保有替代药物可用于预防疟疾。
