Malaria prophylaxis: an ever-changing problem

The number of cases of malaria diagnosed in the United Kingdom continued to rise throughout the 1970s, reached an apparent plateau of about 2,000 cases a year in 1978 and 1979, and then declined slightly in 1980 and 1981, with 1576 cases in the latter year.1 The number of deaths due to Plasmodium falciparum infection has remained level at about six each year throughout the decade. Most of these infections and deaths could have been prevented by prophylaxis. Malaria risk is present in many parts of Africa, Central and Southern America, the Middle and Far East and Oceania; they are listed in a BMJ report.2 We have discussed this subject three times in recent years,3–5 but the rapid changes in susceptibility of plasmodia to antimalarial drugs require frequent revision of regimens for prophylaxis and treatment.