Many infectious diseases are more prevalent in other areas of the world. In this article, we will cover three important travel diseases along with their prophylaxis and treatment recommendations that may show up on your board exam.
Malaria
Malaria is caused by the infectious agent Plasmodium, which is a protozoan parasite. Transmission primarily occurs through mosquito bites. Therefore, prevention of malaria includes the use of mosquito repellents or mosquito nets. The CDC recommended prophylaxis treatment for malaria includes a variety of medications that are suited for different patients’ needs. Atovaquone-proguanil, doxycycline, primaquine, and tafenoquine are all medications that can be started days before traveling and are taken daily. Other prophylaxis regimens include chloroquine and mefloquine, which are medications that are taken weekly and are considered for use in pregnancy. Each country has more prevalent species of Plasmodium, and this is a consideration for choosing which prophylaxis regimen to use. The avoidance of mosquitoes is another recommended action to take in preventing malaria. For the treatment guidelines for malaria, the CDC recommends using either atovaquone–proguanil or artemether-lumefantrine. The dosing for atovaquone–proguanil is a once-a-day weight-based dose for pediatrics, while for adults it is a fixed 4 tablets once daily. The dosing for artemether-lumefantrine is weight-based for both pediatrics and adults, and it is given twice daily. Both medications are given for three days. One note for the selection of malaria treatment is that the treatment medication should be different, or not related to the prophylaxis medication.
Typhoid fever
Typhoid fever is caused by the infectious agent Salmonella enterica. There is no prophylactic medication for the prevention of typhoid fever. The main prevention tactic to prevent typhoid fever is through consuming safe food and water, as well as washing your hands frequently. However, there is a typhoid vaccine that is available for patients traveling to areas with increased risk of typhoid fever. The CDC recommends the vaccine for travelers 2 years and older. There are two different formulations of the typhoid vaccine. It comes as an oral capsule and IM injection. The primary series for the capsule version is 1 capsule every other day for 4 days. Then a booster of the capsule vaccine can be given every 5 years to those at risk for typhoid fever. The primary series for the IM injection is one injection and can be repeated every 2 years for those at risk for typhoid fever. For empiric treatment of typhoid fever, the patient’s travel history will guide empiric treatment. Generally, for most countries, the CDC recommends the combined regimen of azithromycin and ceftriaxone. We’ve covered both medications in previous podcast episodes: ceftriaxone, azithromycin. In patients coming back from countries like Iraq or Pakistan, azithromycin is used in uncomplicated cases, and a carbapenem is used in complicated cases. Cultures are used for directed treatment to narrow antibiotic choice.
Yellow Fever
Yellow fever is caused by the yellow fever virus. There are no medications available to be used for prophylaxis or the treatment of yellow fever. Treatment of yellow fever includes the use of supportive care, utilizing fluids, rest, analgesics, and antipyretics. The best way to prevent yellow fever is by preventing mosquito bites. As stated before, the use of mosquito repellants or mosquito nets is effective. There is a yellow fever vaccine available. The CDC recommends it for ages 9 months or older traveling to areas with risk for yellow fever. It is usually a one-time dose vaccine, with the booster dose not being generally recommended for most people.
This article was written by Hunter Backholm, PharmD, Candidate in collaboration with Eric Christianson, PharmD, BCPS, BCGP
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