An Englishman travels to a place which isresistant to chloroquine and mefloquine. What should he take as prophylaxis ?
## **Core Concept**
The question tests the knowledge of malaria prophylaxis, specifically in areas resistant to chloroquine and mefloquine. Malaria prophylaxis involves the use of medications to prevent malaria in travelers to endemic areas. The choice of prophylactic agent depends on the resistance patterns of the malaria parasites in that region.
## **Why the Correct Answer is Right**
Atovaquone-proguanil (**) is effective against chloroquine-resistant and mefloquine-resistant strains of Plasmodium falciparum. It works by inhibiting the electron transport chain in the mitochondria of the parasite and also interferes with DNA synthesis. This combination is a recommended option for travelers to areas with resistance to chloroquine and mefloquine.
## **Why Each Wrong Option is Incorrect**
* **Option A:** Chloroquine is not effective in areas resistant to it, making it an incorrect choice for areas with chloroquine resistance.
* **Option B:** Mefloquine is not effective in areas resistant to it, and its use might also be limited by resistance or contraindications in some cases.
* **Option D:** Doxycycline is an alternative for prophylaxis but is generally considered after atovaquone-proguanil in some guidelines due to its side effects and the need for daily dosing.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that atovaquone-proguanil is a preferred option for malaria prophylaxis in many areas with resistance to chloroquine and mefloquine, especially for short-term travelers. It's essential to check the latest guidelines and resistance patterns before prescribing.
## **Correct Answer:** . Atovaquone-proguanil