A 28-year-old software engineer is travelling to sub-Saharan Africa for six weeks. He has no contraindications to any antimalarial. Which chemoprophylactic regimen is appropriate?

• A Chloroquine 300 mg base once weekly, started 1 week before travel and continued 4 weeks after return
• B Artemether-lumefantrine one tablet daily throughout the trip
• C Primaquine 15 mg base once daily, started on the day of departure and stopped on return
• D Doxycycline 100 mg once daily, started 2 days before travel and continued 4 weeks after leaving the endemic area ✓

Explanation

Doxycycline 100 mg daily begun 2 days before entry and continued for 4 weeks after leaving is a standard regimen for chloroquine-resistant areas such as sub-Saharan Africa. Chloroquine is inappropriate because P. falciparum resistance there is nearly universal. Primaquine is used for terminal prophylaxis against vivax hypnozoites, not as primary falciparum prophylaxis, and artemisinin combinations are treatment drugs, never prophylactic agents.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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