Malaria

One of the big issues that countries in this part of the world still suffer with is Malaria which is spread by Mosquitoes.   In talking with my Doctor this is tricky as different Malaria strains have developed a resistance to medications.  In my research it looks like Atovaquone-proguanil may be the best option.  In the western parts of Cambodia there are strains that are resistant to Mefloquine. 



Here is a complete listing of the Meds:

Table 3-10. Considerations when choosing a drug for malaria prophylaxis

DRUG	REASONS TO CONSIDER USE OF THIS DRUG	REASONS TO CONSIDER AVOIDING USE OF THIS DRUG
Atovaquone-proguanil	Good for last-minute travelers because the drug is started 1–2 days before travel Some people prefer to take a daily medicine Good choice for shorter trips because you have to take the medicine for only 7 days after traveling rather than 4 weeks Well tolerated—side effects uncommon Pediatric tablets are available and may be more convenient	Cannot be used by women who are pregnant or breastfeeding a child that weighs <5 kg Cannot be taken by people with severe renal impairment Tends to be more expensive than some of the other options (especially for long trips) Some people (including children) would rather not take a medicine every day
Chloroquine	Some people would rather take medicine weekly Good choice for long trips because it is taken only weekly Some people are already taking hydroxychloroquine chronically for rheumatologic conditions; in those instances, they may not have to take an additional medicine Can be used in all trimesters of pregnancy	Cannot be used in areas with chloroquine or mefloquine resistance May exacerbate psoriasis Some people would rather not take a weekly medication For short trips, some people would rather not take medication for 4 weeks after travel Not a good choice for last-minute travelers, because drug needs to be started 1–2 weeks before travel
Doxycycline	Some people prefer to take a daily medicine Good for last-minute travelers because the drug is started 1–2 days before travel Tends to be the least expensive antimalarial People who are already taking doxycycline chronically to prevent acne do not have to take an additional medicine Doxycycline also can prevent some additional infections (such as rickettsial infections and leptospirosis), so it may be preferred by people planning to hike, camp, and swim in fresh water	Cannot be used by pregnant women and children aged <8 years Some people would rather not take a medicine every day For short trips, some people would rather not take medication for 4 weeks after travel Women prone to getting vaginal yeast infections when taking antibiotics may prefer taking a different medicine People may want to avoid the increased risk of sun sensitivity Some people are concerned about the potential of getting an upset stomach from doxycycline
Mefloquine	Some people would rather take medicine weekly Good choice for long trips because it is taken only weekly Can be used during pregnancy	Cannot be used in areas with mefloquine resistance Cannot be used in patients with certain psychiatric conditions Cannot be used in patients with a seizure disorder Not recommended for people with cardiac conduction abnormalities Not a good choice for last-minute travelers because drug needs to be started at least 2 weeks before travel Some people would rather not take a weekly medication For short trips, some people would rather not take medication for 4 weeks after travel
Primaquine	It is the most effective medicine for preventing P. vivax, so it is a good choice for travel to places with more than 90% P. vivax Good choice for shorter trips because you only have to take the medicine for 7 days after traveling rather than 4 weeks Good for last-minute travelers because the drug is started 1–2 days before travel Some people prefer to take a daily medicine	Cannot be used in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency Cannot be used in patients who have not been tested for G6PD deficiency There are costs and delays associated with getting a G6PD test; however, it only has to be done once. Once a normal G6PD level is verified and documented, the test does not have to be repeated the next time primaquine is considered Cannot be used by pregnant women Cannot be used by women who are breastfeeding, unless the infant has also been tested for G6PD deficiency Some people (including children) would rather not take a medicine every day Some people are concerned about the potential of getting an upset stomach from primaquine

We shall see what the Doctor recommends when we consult.