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December 3, 1997, Vol 278, No. 21 >
ARTICLE | December 3, 1997

Update on Prevention of Malaria for Travelers FREE

Hans O. Lobel, MD, MPH; Phyllis E. Kozarsky, MD
[+] Author Affiliations

The opinions expressed herein are the private views of the authors and are not to be construed as official views of the Centers for Disease Control and Prevention, US Public Health Service, or the US Department of Health and Human Services.

Reprints: Hans O. Lobel, MD, MPH, Mailstop F22, Centers for Disease Control and Prevention, Atlanta, GA 30333 (e-mail: hol1@cdc.gov).


JAMA. 1997;278(21):1767-1771. doi:10.1001/jama.1997.03550210065040
Text Size: A A A
Published online
Article
References

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.

REFERENCES

1 +
Behrens RH, Curtis CF.  Malaria in travellers: epidemiology and prevention . Br Med Bull . 1993;;49:363-381.
2 +
Hoffman SL. Diagnosis,treatment andprevention of malaria . Med Clin North Am . 1992;;76:1327-1355.
3 +
Greenberg AE, Lobel HO.  Mortality from Plasmodium falciparum malaria in travelers from the United States, 1959 to 1987 . Ann Intern Med . 1990;;113:326-327.
4 +
Centers for Disease Control and Prevention. Health Information for International Travel 1996-97 . Atlanta, Ga: Centers for Disease Control and Prevention; 1997;.
5 +
World Health Organization. International Travel and Health: Vaccination Certificate Requirements and Health Advice, 1997 . Geneva, Switzerland: World Health Organization; 1997;.
6 +
Lobel HO, Kozarsky PE, Barber AM, Blass M, Waterman SH, Campbell CC. Pre-travel health advice to international travelers by primary care physicians. In: Program and abstracts of the 42nd annual meeting of the American Society of Tropical Medicine and Hygiene; October 31-November 4, 1993; Atlanta, Ga. Abstract 274.
7 +
Keystone JS, Dismukes R, Sawyer L, Kozarsky PE.  Inadequacies in health recommendations provided for international travelers by North American travel health advisors . J Trav Med . 1994;;1:72-78.
8 +
Held TK, Weinke T, Mansmann U, Trautmann M, Pohle HD.  Malaria prophylaxis: identifying risk groups for noncompliance . QJM . 1994;;87:17-22.
9 +
Peragallo MS, Cali G, Sarnicola G. Tolerance of long-term malaria chemoprophylaxis with chloroquine plus proguanil and with mefloquine among Italian troops deployed in Somalia and Mozambique. In: Program and abstracts of the Fifth International Conference on Travel Medicine; March 24-27, 1997; Geneva, Switzerland. Abstract 175.
10 +
Lobel HO, Phillips-Howard PA, Brandling-Bennett AD, et al.  Malaria incidence and prevention among European and North American travelers to Kenya . Bull World Health Organ . 1990;;68:209-215.
11 +
Tsai TF.  Arboviral infections: general considerations for prevention, diagnosis, and treatment in travelers . Semin Pediatr Infect Dis . 1992;;3( (1) ):62-69.
12 +
 Are insect repellents safe? Lancet . 1988;;2:610-611. Editorial.
13 +
Lobel HO, Campbell CC.  Malaria prophylaxis and distribution of drug resistance . In: Strickland GT, ed. Clinics in Tropical Medicine and Communicable Diseases . London, England: WB Saunders Co; 1986;;1:225-242.
14 +
Schuurkamp GJ, Spicer PE, Kereu RK, Bulungol PK, Rieckmann KH.  Chloroquine-resistant Plasmodium vivax in Papua New Guinea . Trans R Soc Trop Med Hyg . 1992;;86:121-122.
15 +
Than M, Kyaw MP, Soe AY, Gyi KK, Sabai M, Oo M.  Development of resistance to chloroquine by Plasmodium vivax in Myanmar . Trans R Soc Trop Med Hyg . 1995;;89:307-308.
16 +
Schwartz IK, Lackritz EM, Patchen LC.  Chloroquine-resistant Plasmodium vivax from Indonesia . N Engl J Med . 1991;;324:927.
17 +
Wyler DJ.  Malaria chemoprophylaxis for the traveler . N Engl J Med . 1993;;329:31-37.
18 +
Lampe AS, Bakker RB, Smith SJ.  Dangers of antimalarial standby treatment . Eur J Clin Microbiol Infect Dis . 1994;;13:332.
19 +
Steffen R, Fuchs E, Schildknecht J, et al.  Mefloquine compared with other malaria chemoprophylactic regimens in tourists visiting East Africa . Lancet . 1993;;341:1299-1303.
20 +
Lobel HO, Miani M, Eng T, Bernard KW, High-tower AW, Campbell CC.  Long-term malaria prophylaxis with weekly mefloquine . Lancet . 1993;;341:848-851.
21 +
Ohrt C, Richie TL, Widjaja H, et al.  A double-blind placebo-controlled trial of mefloquine versus doxycycline for the prophylaxis of malaria in Indonesian soldiers . Ann Intern Med . 1997;;126:963-972.
22 +
Choo V.  Uncertainty about mefloquine will take time to resolve . Lancet . 1996;;347:891.
23 +
Cook G.  Malaria prophylaxis: mefloquine toxicity should limit its use to treatment alone . BMJ . 1995;;311:190-191.
24 +
Winstanley P.  Mefloquine: the benefits outweigh the risks . Br J Clin Pharmacol . 1996;;42:411-413.
25 +
Croft AMJ, World MJ.  Neuropsychiatric reactions with mefloquine chemoprophylaxis . Lancet . 1996;;347:326.
26 +
Regier DA, Kaelber CT.  The epidemiologic catchment area (ECA) program: studying the prevalence and incidence of psychopathology . In: Tsuang MT, Tohen M, Zahner GEP, eds. Textbook in Psychiatric Epidemiology . New York, NY: Wiley-Liss; 1995;:135-155.
27 +
Hauser WA, Annegers JF, Anderson VE.  Epidemiology and genesis of epilepsy . In: Ward AA, Penry JK, Purpura D, et al, eds. Epilepsy . New York, NY: Raven Press; 1983;:267-294.
28 +
Vuurman EFPM, Muntjewerff ND, Uiterwijk MMC, et al.  Effects of mefloquine alone and with alcohol on psychomotor and driving performance . Eur J Clin Pharmacol . 1996;;50:475-482.
29 +
Davis TME, Dembo LG, Kaye-Eddie SA, et al.  Neurological, cardiovascular and metabolic effects of mefloquine in healthy volunteers: a double-blind, placebo-controlled trial . Br J Clin Pharmacol . 1996;;42:415-421.
30 +
Schlagenhauf P, Lobel HO, Steffen R, et al.  Tolerability of mefloquine in Swissair trainee pilots . Am J Trop Med Hyg . 1997;;56:235-240.
31 +
MacPherson D, Gamble K, Tessier D, et al. Mefloquine tolerance—randomized, double-blinded, placebo-controlled study using a loading dose of mefloquine in pre-exposed travelers. In: Program and abstracts of the Fifth International Conference on Travel Medicine; March 24-27, 1997; Geneva, Switzerland. Abstract 220.
32 +
Nosten F, ter Kuile F, Maelankiri L, et al.  Mefloquine prophylaxis prevents malaria during pregnancy: a double-blind, placebo-controlled study . J Infect Dis . 1994;;169:595-603.
33 +
Boudreau E, Schuster B, Sanchez J, et al.  Tolerability of prophylactic Lariam regimens . Trop Med Parasit . 1993;;44:257-265.
34 +
Arthur JD, Shanks GD, Echeverria P.  Mefloquine prophylaxis . Lancet . 1990;;1:972.
35 +
Arthur JD, Echeverria P, Shanks GD, Karwacki J, Bodhidatta L, Brown JE.  A comparative study of gastrointestinal infections in United States soldiers receiving doxycycline or mefloquine for malaria prophylaxis . Am J Trop Med Hyg . 1990;;43:608-613.
36 +
Croft AMJ, Clayton TC, World MJ.  Side effects of mefloquine prophylaxis for malaria: an independent randomized controlled trial . Trans R Soc Trop Med Hyg . 1997;;91:199-203.
37 +
Steketee RW, Wirima JJ, Slutsker L, et al.  Malaria treatment and prevention in pregnancy: indications for use and adverse events associated with use of chloroquine or mefloquine . Am J Trop Med Hyg . 1996;;55:50-56.
38 +
Huzly D, Schonfeld C, Beuerle W, et al.  Malaria chemoprophylaxis in German tourists: a prospective study on compliance and adverse reactions . J Travel Med . 1996;;3:148-155.
39 +
Wallace MR, Sharp TW, Smoak B, et al.  Malaria among United States troops in Somalia . Am J Med . 1996;;100:49-55.
40 +
Barrett PJ, Emmins PD, Clarke PD, Bradley DJ.  Comparison of adverse events associated with use of mefloquine and combination of chloroquine and proguanil as antimalarial prophylaxis: postal and telephone survey of travellers . BMJ . 1996;;313:525-528.
41 +
Hopperus Buma APCC, van Thiel PPAM, Lobel HO, et al.  Long-term malaria chemoprophylaxis with mefloquine in Dutch Marines in Cambodia . J Infect Dis . 1996;;173:1506-1509.
42 +
Jaspers CAJJ, Hopperus Buma APCC, van Thiel PPAM, et al.  Tolerance of mefloquine chemoprophylaxis in Dutch military personnel . Am J Trop Med Hyg . 1996;;55:230-234.
43 +
Takeshima S.  Side effects with mefloquine for long-term malaria prophylaxis . Jpn J Trop Med Hyg . 1994;;22:185-192.
44 +
Pennie RA, Koren G, Crevoisier C.  Steady state pharmacokinetics of mefloquine in long-term travellers . Trans R Soc Trop Med Hyg . 1993;;87:459-462.
45 +
Luxemburger C, Price RN, Nosten F, Ter Kuile FO, Chongsuphajaisiddhi T, White N.  Mefloquine in infants and young children . Ann Trop Paediatr . 1996;;16:281-286.
46 +
Phillips-Howard PA, Wood D.  The safety of antimalarial drugs in pregnancy . Drug Saf . 1996;;14:131-145.
47 +
Balocco R, Bonati M.  Mefloquine prophylaxis against malaria for female travelers of childbearing age . Lancet . 1992;;340:309-310.
48 +
Smoak BL, Writer JV, Keep LW, et al.  The effects of inadvertent exposure of mefloquine chemoprophylaxis on pregnancy outcomes and infants of US Army service women . J Infect Dis . 1997;;176:831-833.
49 +
Vanhauwere B, Maradit H, Kerr L. Post-marketing surveillance of prophylactic Lariam use in pregnancy. Am J Trop Med Hyg. In press.
50 +
Shanks GD.  The rise and fall of mefloquine as an antimalarial drug in South East Asia . Mil Med . 1994;;159:275-281.
51 +
Brasseur P, Kouamouo J, Moyou-Somo R, Druilhe P.  Multi-drug resistant falciparum malaria in Cameroon 1987-88 . Am J Trop Med Hyg . 1992;;46:8-14.
52 +
Lobel HO, Varma JK, Miani M, et al. Monitoring for mefloquine-resistant Plasmodium falciparum in Africa: implications for travelers' health. Am J Trop Med Hyg. In press.
53 +
Pang LW, Limsomwong N, Boudreau EF.  Doxycycline prophylaxis for falciparum malaria . Lancet . 1987;;1:1161-1164.
54 +
Singharaj P, Eamsila C, Bhothisuwan A.  Efficacy of doxycycline on malaria prophylaxis in the soldiers deployed to the Thai-Kampuchean border . R Thai Army Med J . 1987;;40:165-171.
55 +
Watanasook C, Singharaj P, Surlyamongkol V, et al.  Malaria prophylaxis with doxycycline in soldiers deployed to the Thai-Kampuchean border . Southeast Asian J Trop Med Public Health . 1989;;20:61-64.
56 +
Delaney TJ, Leppard BJ, MacDonald DM.  Effects of long term treatment with tetracycline . Acta Derm Venereol (Stockh) . 1974;;54:487-489.
57 +
Fish DR, Espir MLE.  Convulsions associated with prophylactic antimalarial drugs: implications for people with epilepsy . BMJ . 1988;;297:526-527.
58 +
Lovestone S.  Chloroquine-induced mania . Br J Psych . 1991;;159:164-165.
59 +
Bruce-Chwatt LJ, Bruce-Chwatt JM.  Antimalarial drugs in West Africa, with particular reference to proguanil . BMJ . 1950;;2:7-14.
60 +
Shanks GD.  Drugs for prophylaxis and treatment of malaria . J Travel Med . 1994;;1:40-47.
61 +
Collins WE, Jeffery GM.  Primaquine resistance in Plasmodium vivax . Am J Trop Med Hyg . 1996;;55:243-249.
62 +
Bernard KW, Smith PW, Kader FJ, Moran MJ.  Neuroparalytic illness and human diploid cell rabies vaccine . JAMA . 1982;;248:3136-3138.
63 +
Creagh TH.  The use of cohort studies in pharmacoepidemiology . In: Strom BL, Velo G, eds. Drug Epidemiology and Post-Marketing Surveillance . New York, NY: Plenum Publishing Corp; 1992;:53-58.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Behrens RH, Curtis CF.  Malaria in travellers: epidemiology and prevention . Br Med Bull . 1993;;49:363-381.
2 +
Hoffman SL. Diagnosis,treatment andprevention of malaria . Med Clin North Am . 1992;;76:1327-1355.
3 +
Greenberg AE, Lobel HO.  Mortality from Plasmodium falciparum malaria in travelers from the United States, 1959 to 1987 . Ann Intern Med . 1990;;113:326-327.
4 +
Centers for Disease Control and Prevention. Health Information for International Travel 1996-97 . Atlanta, Ga: Centers for Disease Control and Prevention; 1997;.
5 +
World Health Organization. International Travel and Health: Vaccination Certificate Requirements and Health Advice, 1997 . Geneva, Switzerland: World Health Organization; 1997;.
6 +
Lobel HO, Kozarsky PE, Barber AM, Blass M, Waterman SH, Campbell CC. Pre-travel health advice to international travelers by primary care physicians. In: Program and abstracts of the 42nd annual meeting of the American Society of Tropical Medicine and Hygiene; October 31-November 4, 1993; Atlanta, Ga. Abstract 274.
7 +
Keystone JS, Dismukes R, Sawyer L, Kozarsky PE.  Inadequacies in health recommendations provided for international travelers by North American travel health advisors . J Trav Med . 1994;;1:72-78.
8 +
Held TK, Weinke T, Mansmann U, Trautmann M, Pohle HD.  Malaria prophylaxis: identifying risk groups for noncompliance . QJM . 1994;;87:17-22.
9 +
Peragallo MS, Cali G, Sarnicola G. Tolerance of long-term malaria chemoprophylaxis with chloroquine plus proguanil and with mefloquine among Italian troops deployed in Somalia and Mozambique. In: Program and abstracts of the Fifth International Conference on Travel Medicine; March 24-27, 1997; Geneva, Switzerland. Abstract 175.
10 +
Lobel HO, Phillips-Howard PA, Brandling-Bennett AD, et al.  Malaria incidence and prevention among European and North American travelers to Kenya . Bull World Health Organ . 1990;;68:209-215.
11 +
Tsai TF.  Arboviral infections: general considerations for prevention, diagnosis, and treatment in travelers . Semin Pediatr Infect Dis . 1992;;3( (1) ):62-69.
12 +
 Are insect repellents safe? Lancet . 1988;;2:610-611. Editorial.
13 +
Lobel HO, Campbell CC.  Malaria prophylaxis and distribution of drug resistance . In: Strickland GT, ed. Clinics in Tropical Medicine and Communicable Diseases . London, England: WB Saunders Co; 1986;;1:225-242.
14 +
Schuurkamp GJ, Spicer PE, Kereu RK, Bulungol PK, Rieckmann KH.  Chloroquine-resistant Plasmodium vivax in Papua New Guinea . Trans R Soc Trop Med Hyg . 1992;;86:121-122.
15 +
Than M, Kyaw MP, Soe AY, Gyi KK, Sabai M, Oo M.  Development of resistance to chloroquine by Plasmodium vivax in Myanmar . Trans R Soc Trop Med Hyg . 1995;;89:307-308.
16 +
Schwartz IK, Lackritz EM, Patchen LC.  Chloroquine-resistant Plasmodium vivax from Indonesia . N Engl J Med . 1991;;324:927.
17 +
Wyler DJ.  Malaria chemoprophylaxis for the traveler . N Engl J Med . 1993;;329:31-37.
18 +
Lampe AS, Bakker RB, Smith SJ.  Dangers of antimalarial standby treatment . Eur J Clin Microbiol Infect Dis . 1994;;13:332.
19 +
Steffen R, Fuchs E, Schildknecht J, et al.  Mefloquine compared with other malaria chemoprophylactic regimens in tourists visiting East Africa . Lancet . 1993;;341:1299-1303.
20 +
Lobel HO, Miani M, Eng T, Bernard KW, High-tower AW, Campbell CC.  Long-term malaria prophylaxis with weekly mefloquine . Lancet . 1993;;341:848-851.
21 +
Ohrt C, Richie TL, Widjaja H, et al.  A double-blind placebo-controlled trial of mefloquine versus doxycycline for the prophylaxis of malaria in Indonesian soldiers . Ann Intern Med . 1997;;126:963-972.
22 +
Choo V.  Uncertainty about mefloquine will take time to resolve . Lancet . 1996;;347:891.
23 +
Cook G.  Malaria prophylaxis: mefloquine toxicity should limit its use to treatment alone . BMJ . 1995;;311:190-191.
24 +
Winstanley P.  Mefloquine: the benefits outweigh the risks . Br J Clin Pharmacol . 1996;;42:411-413.
25 +
Croft AMJ, World MJ.  Neuropsychiatric reactions with mefloquine chemoprophylaxis . Lancet . 1996;;347:326.
26 +
Regier DA, Kaelber CT.  The epidemiologic catchment area (ECA) program: studying the prevalence and incidence of psychopathology . In: Tsuang MT, Tohen M, Zahner GEP, eds. Textbook in Psychiatric Epidemiology . New York, NY: Wiley-Liss; 1995;:135-155.
27 +
Hauser WA, Annegers JF, Anderson VE.  Epidemiology and genesis of epilepsy . In: Ward AA, Penry JK, Purpura D, et al, eds. Epilepsy . New York, NY: Raven Press; 1983;:267-294.
28 +
Vuurman EFPM, Muntjewerff ND, Uiterwijk MMC, et al.  Effects of mefloquine alone and with alcohol on psychomotor and driving performance . Eur J Clin Pharmacol . 1996;;50:475-482.
29 +
Davis TME, Dembo LG, Kaye-Eddie SA, et al.  Neurological, cardiovascular and metabolic effects of mefloquine in healthy volunteers: a double-blind, placebo-controlled trial . Br J Clin Pharmacol . 1996;;42:415-421.
30 +
Schlagenhauf P, Lobel HO, Steffen R, et al.  Tolerability of mefloquine in Swissair trainee pilots . Am J Trop Med Hyg . 1997;;56:235-240.
31 +
MacPherson D, Gamble K, Tessier D, et al. Mefloquine tolerance—randomized, double-blinded, placebo-controlled study using a loading dose of mefloquine in pre-exposed travelers. In: Program and abstracts of the Fifth International Conference on Travel Medicine; March 24-27, 1997; Geneva, Switzerland. Abstract 220.
32 +
Nosten F, ter Kuile F, Maelankiri L, et al.  Mefloquine prophylaxis prevents malaria during pregnancy: a double-blind, placebo-controlled study . J Infect Dis . 1994;;169:595-603.
33 +
Boudreau E, Schuster B, Sanchez J, et al.  Tolerability of prophylactic Lariam regimens . Trop Med Parasit . 1993;;44:257-265.
34 +
Arthur JD, Shanks GD, Echeverria P.  Mefloquine prophylaxis . Lancet . 1990;;1:972.
35 +
Arthur JD, Echeverria P, Shanks GD, Karwacki J, Bodhidatta L, Brown JE.  A comparative study of gastrointestinal infections in United States soldiers receiving doxycycline or mefloquine for malaria prophylaxis . Am J Trop Med Hyg . 1990;;43:608-613.
36 +
Croft AMJ, Clayton TC, World MJ.  Side effects of mefloquine prophylaxis for malaria: an independent randomized controlled trial . Trans R Soc Trop Med Hyg . 1997;;91:199-203.
37 +
Steketee RW, Wirima JJ, Slutsker L, et al.  Malaria treatment and prevention in pregnancy: indications for use and adverse events associated with use of chloroquine or mefloquine . Am J Trop Med Hyg . 1996;;55:50-56.
38 +
Huzly D, Schonfeld C, Beuerle W, et al.  Malaria chemoprophylaxis in German tourists: a prospective study on compliance and adverse reactions . J Travel Med . 1996;;3:148-155.
39 +
Wallace MR, Sharp TW, Smoak B, et al.  Malaria among United States troops in Somalia . Am J Med . 1996;;100:49-55.
40 +
Barrett PJ, Emmins PD, Clarke PD, Bradley DJ.  Comparison of adverse events associated with use of mefloquine and combination of chloroquine and proguanil as antimalarial prophylaxis: postal and telephone survey of travellers . BMJ . 1996;;313:525-528.
41 +
Hopperus Buma APCC, van Thiel PPAM, Lobel HO, et al.  Long-term malaria chemoprophylaxis with mefloquine in Dutch Marines in Cambodia . J Infect Dis . 1996;;173:1506-1509.
42 +
Jaspers CAJJ, Hopperus Buma APCC, van Thiel PPAM, et al.  Tolerance of mefloquine chemoprophylaxis in Dutch military personnel . Am J Trop Med Hyg . 1996;;55:230-234.
43 +
Takeshima S.  Side effects with mefloquine for long-term malaria prophylaxis . Jpn J Trop Med Hyg . 1994;;22:185-192.
44 +
Pennie RA, Koren G, Crevoisier C.  Steady state pharmacokinetics of mefloquine in long-term travellers . Trans R Soc Trop Med Hyg . 1993;;87:459-462.
45 +
Luxemburger C, Price RN, Nosten F, Ter Kuile FO, Chongsuphajaisiddhi T, White N.  Mefloquine in infants and young children . Ann Trop Paediatr . 1996;;16:281-286.
46 +
Phillips-Howard PA, Wood D.  The safety of antimalarial drugs in pregnancy . Drug Saf . 1996;;14:131-145.
47 +
Balocco R, Bonati M.  Mefloquine prophylaxis against malaria for female travelers of childbearing age . Lancet . 1992;;340:309-310.
48 +
Smoak BL, Writer JV, Keep LW, et al.  The effects of inadvertent exposure of mefloquine chemoprophylaxis on pregnancy outcomes and infants of US Army service women . J Infect Dis . 1997;;176:831-833.
49 +
Vanhauwere B, Maradit H, Kerr L. Post-marketing surveillance of prophylactic Lariam use in pregnancy. Am J Trop Med Hyg. In press.
50 +
Shanks GD.  The rise and fall of mefloquine as an antimalarial drug in South East Asia . Mil Med . 1994;;159:275-281.
51 +
Brasseur P, Kouamouo J, Moyou-Somo R, Druilhe P.  Multi-drug resistant falciparum malaria in Cameroon 1987-88 . Am J Trop Med Hyg . 1992;;46:8-14.
52 +
Lobel HO, Varma JK, Miani M, et al. Monitoring for mefloquine-resistant Plasmodium falciparum in Africa: implications for travelers' health. Am J Trop Med Hyg. In press.
53 +
Pang LW, Limsomwong N, Boudreau EF.  Doxycycline prophylaxis for falciparum malaria . Lancet . 1987;;1:1161-1164.
54 +
Singharaj P, Eamsila C, Bhothisuwan A.  Efficacy of doxycycline on malaria prophylaxis in the soldiers deployed to the Thai-Kampuchean border . R Thai Army Med J . 1987;;40:165-171.
55 +
Watanasook C, Singharaj P, Surlyamongkol V, et al.  Malaria prophylaxis with doxycycline in soldiers deployed to the Thai-Kampuchean border . Southeast Asian J Trop Med Public Health . 1989;;20:61-64.
56 +
Delaney TJ, Leppard BJ, MacDonald DM.  Effects of long term treatment with tetracycline . Acta Derm Venereol (Stockh) . 1974;;54:487-489.
57 +
Fish DR, Espir MLE.  Convulsions associated with prophylactic antimalarial drugs: implications for people with epilepsy . BMJ . 1988;;297:526-527.
58 +
Lovestone S.  Chloroquine-induced mania . Br J Psych . 1991;;159:164-165.
59 +
Bruce-Chwatt LJ, Bruce-Chwatt JM.  Antimalarial drugs in West Africa, with particular reference to proguanil . BMJ . 1950;;2:7-14.
60 +
Shanks GD.  Drugs for prophylaxis and treatment of malaria . J Travel Med . 1994;;1:40-47.
61 +
Collins WE, Jeffery GM.  Primaquine resistance in Plasmodium vivax . Am J Trop Med Hyg . 1996;;55:243-249.
62 +
Bernard KW, Smith PW, Kader FJ, Moran MJ.  Neuroparalytic illness and human diploid cell rabies vaccine . JAMA . 1982;;248:3136-3138.
63 +
Creagh TH.  The use of cohort studies in pharmacoepidemiology . In: Strom BL, Velo G, eds. Drug Epidemiology and Post-Marketing Surveillance . New York, NY: Plenum Publishing Corp; 1992;:53-58.

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