Implementation of pretravel advice: Good for malaria, bad for diarrhoea

Pretravel immunisations and health advice can substantially reduce the inci dence of travel-related diseases. The aim of this study was to evaluate the implementation of pretravel advice among a homogenous group of students, w ho received similar written information on vaccination requirements and hea lth advice. They were referred to the travel clinic (50%) or a general prac titioner (50%) for vaccination, counselling and prescriptions. Eighty-four out of 110 students (76%) returned the questionnaire. Insect repellent was used by all and only 10 used the repellent for less th an 75% of the time spent in malaria endemic areas. Malaria chemoprophylaxis was taken by all but one : chloroquine plus proquanil by 12 and mefloquine by 71. Reported compliance with the dosing regimen was optimal in 64 stude nts, 9 missed one dose and 10 stopped too early. Side effects due to antima larials were reported by 25 (30%). Diarrhoea during travel occurred in 43 s tudents (51%). Loperamide was used by 34 students with diarrhoea (79%), but only 2 out of 27 students with moderate to severe diarrhoea used the recom mended self-treatment with a fluoroquinolone antibiotic. In conclusion, the recommendations of malaria prophylaxis were well impleme nted by most travellers despite a high incidence of self-reported side effe cts to antimalarials. The incidence of traveller's diarrhoea was high and t he recommendation for early self-treatment of moderate to severe diarrhoea with a fluoroquinolone antibiotic in combination with loperamide was not pu t into practice.