JAMA devotes the bulk of its issue this week to malaria, and two articles seem of special interest to readers who advise travelers about prophylaxis or who treat cases.

One article compares national guidelines and notes a lack of consensus, which if achieved, could improve compliance with chemoprophylaxis. On the controversy over the safety of mefloquine (Lariam), the authors write that while the available data on neuropsychiatric effects are limited, large studies find a low incidence of serious adverse events. Additionally, they say, the drug is not associated with adverse effects on driving, flying, or diving among those who tolerate it.

Another controversy concerns the use of blood-stage–only chemoprophylaxis in places where P. vivax is prevalent. Since the organism escapes those drugs in the liver, patients need to be warned that prophylaxis with drugs other than primaquine could leave them vulnerable and that they should seek medical advice for febrile illnesses occurring up to a year after exposure.


An article on treatment urges rapid diagnosis, even with use of the CDC's telediagnosis service if needed, because many U.S. deaths from malaria were associated with delayed diagnosis and treatment. It offers a species-specific treatment algorithm.

Dr B, any links we can go to and educate ourselves? Malaria med's are questioned and discussed here on a regular basis, with many confusing more than learning. Thanks, LDK