Although mefloquine is given as an option for chemoprophylaxis, there are currently no mefloquine-containing products available in South Africa – Lariam® has been discontinued in this country and Cipla have manufacturing issues regarding Mefliam® that will take a while to be resolved. This means that there is currently no product that can be used for pregnant travellers or children weighing less than 11 kg. As these are also the travellers at highest risk of complicated malaria, they should be strongly advised not to go to malaria risk areas. If they have no option but to go, they should use all methods available to prevent getting bitten by the mosquitoes, and should seek immediate medical attention should they have any signs of illness.
There have been some important changes to the guidelines.
- Both doxycycline and atovaquone-proguanil are now S2 and are available from pharmacies without a prescription.
- The South African Malaria Risk Map has been updated, and some areas that were previously low risk areas are now classified as moderate risk. The changes have been made based on notifications of confirmed cases of locally acquired malaria infections over the past five malaria seasons (2014-2018). See page 40 of the guidelines