Pharmacist Counseling Points for Malaria Prevention

According to the CDC, approximately 1500-2000 cases of malaria are reported each year in the United States, mostly in recent travelers. Worldwide, areas at high risk for malaria transmission include warmer regions closer to the equator, such as in Africa and parts of Oceania.

The World Health Organization, which is calling attention to the importance of malaria prevention today, on World Malaria Day, reports that groups most at risk of contracting malaria include infants, children under 5 years of age, pregnant women, and patients with HIV/AIDs, as well as non-immune migrants, mobile populations, and travelers.

Many patients who travel are given preventive drug therapies such as chloroquine, mefloquine, malarone (Atovaquone/Proguanil), and doxycycline. It’s important for pharmacists to understand the considerations in choosing the right antimalarial and to educate patients about travel health steps they can take to reduce their risk when visiting countries prone to malaria transmission.

In this video, Jeff Goad, Pharm D, MPH provided some considerations that pharmacists should use when guiding patients on their choices of an antimalarial:

• Understand resistance patterns.

In areas such as Africa, Southeast Asia, and South America, chloroquine should not be used because the common malaria species in these regions are resistant to the drug. However, chloroquine would be the drug of choice in Central America, where the species of malaria is still susceptible to its treatment.

2. Understand the patient.

Pharmacists should also consider the patients themselves. For children, the dosage range may be an important factor. For example, malarone has dosage guidelines that go down to a very small age and weight. The drug also has a wide safety profile for use and can be used in multiple countries.

3. Consider convenience.

Some antimalarials have different dosing schedules than others. For example, chloroquine and mefloquine need to be taken 1-2 weeks before the patient leaves, once a week while at the destination, and once a week for 4 weeks after they back. However, malarone can be taken 1-2 days before leaving, which would make it a better option for last-minute travelers. It should then be taken once per day while at the destination and then continued once daily for 7 days after they are back.

4. Be aware of the adverse event profile.

Considerations about the adverse effects of each drug should also be a factor. Patients who have seizures, cardiac conduction defects, and mental health issues should not take mefloquine as it can exacerbate those conditions. Doxycycline use warrants counseling as it can increase sun sensitivity, risk of fungal infection in women, and risk of esophagitis. Malarone has minimal adverse effects, but must be taken with a fatty meal to ensure effectiveness.

Additionally, pharmacists can advise traveling patients on what to know about protecting themselves using these counseling points:

• Be mindful of mosquito activity.

It’s important to relay to patients exactly when they are at highest risk of malaria transmission. The Anopheles mosquitoes, which carry malaria, are only active overnight so travelers are only at risk of malaria from dusk to dawn. Travelers should avoid going outside at night in high risk areas and make sure to wear insect repellent if they do.

2. Consider location.

Anopheles mosquitoes prefer warmer temperatures, so accommodations with air conditioning will deter mosquitoes from getting inside. Staying in a hotel that is kept cool and offers fine mesh screens on the windows to keep insects out is the best way to ensure protection during their stay.

3. Remind about personal protection.

Dr. Goad also recommends that travelers purchase an insect net to use as personal protection when sleeping, especially if the accommodation lacks adequate protection. A personal insect net can be bought over the counter and often comes in various holes per square inch, with 400 holes per square inch being the most recommended. Nets that are treated with insecticide are also beneficial in keeping mosquitoes out.

Travelers should make sure that their netting is not open or has any tears while using it, to ensure that no insects can get through.