Chemoprophylaxis for malaria in special cases.

Prophylaxis for malaria is described according to special cases: pregnant w omen, children, aged patients, and taking into account a preexisting pathol ogy: diabetes, renal insufficiency, hepatopathy, epilepsy, psychiatric diso rders with different degrees of severity and intake of psychotropic drugs, and HIV infection. Pregnant women are only allowed the chloroquine + progua nil combination (group 2 and 3 countries). Chloroquine and proguanil may be given to infants but mefloquine is contraindicated under 3 years of age an d for a weight inferior to 15 kg. Chloroquine-proguanil, mefloquine, and do xycycline are not specifically assessed in aged patients but none are contr aindicated. Drug interactions are not well documented: increase of sodium v alproate metabolism with an increased risk of convulsions; severe rhythm di sorders when mefloquine and halofantrine are given simultaneously; interact ion with oral antidiabetic drugs (sulfanilamide) and anti-vitamin K. Severe hepatic insufficiency is a contraindication for mefloquine. Chloroquine an d proguanil are not contraindicated in the case of renal insufficiency. Dos es must be smaller: Mefloquine is contraindicated in patients with a histor y of neuropsychiatric disorders. In HIV-infected patients, caution is recom mended only for Ritonavir, for which surveillance is necessary. The quality of chemoprophylaxis should be assessed taking into account not only risk f actors but also the risk-efficacy ratio of the strategy according to the va rious parameters: case history, location, length, and mode of travel. (C) 1 999 Editions scientifiques et medicales Elsevier SAS.