Malaria chemoprophylaxis in 2005: new policy, new drugs]

For a traveller visiting highly endemic areas for malaria (mainly sub-Saharan Africa), the use of a chemoprophylaxis has to be considered as mandatory in addition to exposure prophylaxis measures (including in migrants largely over-represented among returning travellers with imported malaria). The choice of the appropriate drug depends mainly on the visited area with regard to the level of resistance to chloroquine. Due to the spread of resistance, 7 countries along the West African coast between Senegal and Côte d'Ivoire moved in 2005 from zone 2 to zone 3 (according to the French classification). Recently available and recommanded in zones 2 and 3, the atovaquone+proguanil combination appears to be of great interest due to a good tolerance and an intake limited to the 7 days following return. Alternatively to mefloquine or atovaquone+proguanil, the well tolerated and cheap doxycycline is a good choice but due to its short half life a full compliance is mandatory. In case of fever, even if a chemoprophylaxis is taken, malaria can develop, sometimes with atypical presentations, and has to be systematically considered.