ARALEN® (Chloroquine phosphate), 500 mg (300 mg base) & 250 mg (150 mg base) Trade names in other countries include: Avloclor, Nivaquine, Resochin

• For malaria prevention and treatment.
• Requires a prescription in USA and Canada.
• No resistance yet reported in Dominican Republic, Haiti, Central America, Middle East, and parts of West Africa.
• Keep out of reach of children. Overdose can be fatal.
• Do not use if you have hypersensitivity to 4-aminoquinoline compounds.
• Best tolerated if taken with meals.
• Take 500 mg beginning 1 week before departure and continuing 4 weeks after leaving malarious areas.
• Pediatric dose: 5 mg/kg base (8.3 mg/kg salt) once weekly, up to maximum dose of 300 mg.
• Pharmacists in the USA can pulverize tablets and prepare gelatin capsules with calculated pediatric doses. The dose should be mixed in juice, jelly, or chocolate syrup to hide the extremely bitter taste.
• Side effects (rare) include dizziness, headache, upset stomach, blurred vision, or itching.
• The suspension form is not manufactured in the USA but is widely available overseas.
• Considered safe during pregnancy.
• Inform your healthcare professional if you have liver disease, blood disorders, G-6-PD deficiency, seizure disorder, peptic ulcer disease, Crohn's disease, psoriasis, or ulcerative colitis.
• Per the World Health Organization, this drug should not be taken by persons with a family history of epilepsy.
• Do not use in the presence of retinal or visual field changes.
• A complete eye exam every 3-to-6 months is suggested if you plan to take the drug long term.
• Generally considered safe when taken regularly for prevention for as long as 5 years.
• For "standby treatment" of travelers on chloroquine, physicians may prescribe Fansidar or halofantrine (halofantrine is not available in the USA).
  Dosage recommendations, contraindications, length of treatment, and possible side effects must be determined by a health care provider on an individual basis.

CIPRO® (Ciprofloxacin), 750 mg., 500 mg., 250 mg., and 100 mg. tablets; 1000 mg. time release sequential; an oral suspension is available.

• A fluoroquinolone antibiotic.
• Requires a prescription in USA and Canada.
• Used for severe travelers' diarrhea, with fever, chills, bloody stools, and severe cramping.
• Use 1 tablet twice a day for three days.
• May be taken with or without food (but always with adequate water).
• If there is no fever or there are no bloody stools, you may take two tablets, immediately, accompanied by Imodium® AD, as a single-dose alternative for severe diarrhea.
• Not to be used by pregnant women, nursing mothers, or adolescents under 18 years of age.
• Do not take with milk, yogurt, antacids, probenecid, or theophylline.
• Do not use with Carafate® (sucralfate), Septra DS (or Bactrim DS) or other antibiotics. These products should be taken 2 hours after or 6 hours before Cipro®.
• May cause nausea, diarrhea, headaches, dizziness, or lightheadedness.
• May cause photosensitivity reaction if patients are exposed to excessive sunlight or artificial ultraviolet light. Discontinue this drug if phototoxicity occurs.
• Discontinue immediately if a skin rash or other allergic reactions occur.
• Discontinue immediately if muscle pain, inflammation or tendon rupture occurs.
• Do not use with anticoagulants.
• Notify your health care provider if you have a history of convulsions.
• May also be used for lower respiratory tract infections, some sinus infections, typhoid fever, some infections of the kidneys, bladder, or prostate, severe skin infections, or uncomplicated gonorrhea.
  Dosage recommendations, contraindications, length of treatment, and possible side effects must be determined by a health care provider on an individual basis.

DIAMOX® (Acetazolamide), 125 mg or 250 mg tablet, or 500 mg Timed Released Sequel

• For acute mountain sickness (AMS). The first drug of choice for prevention.
• Requires a prescription in USA and Canada.
• Contains sulfa: do not take if you are allergic to sulfa.
• Do not use in pregnancy.
• Take the 125mg or 250 mg tablet every 12 hours, starting the day of ascent and continue for 3-5 more days.
• Take the Timed Released Sequel once daily.
• Usually used only for heights over 9,000 feet.
• Consider using on a trial basis before departure to minimize unusual or allergic reactions.
• This drug is a diuretic and you will urinate more, so be sure to maintain extra fluid intake.
• Common side effects include a "pins-and-needles" feeling around the lips, toes, and fingers.
• It may cause a strange taste to carbonated drinks.
• If rapid ascent is attempted and Diamox® is being used, prompt descent must be initiated immediately if symptoms of AMS (e.g., some combination of headache, nausea, loss of appetite, fatigue, dizziness, shortness of breath and insomnia) occur.
  Dosage recommendations, contraindications, length of treatment, and possible side effects must be determined by a health care provider on an individual basis.

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• A broad-spectrum antibiotic, effective for malaria prevention.
• Requires a prescription in USA and Canada.
• May decrease the effectiveness of birth control pills.
• Effective for the prevention of chloroquine-resistant and mefloquine-resistant P. falciparum malaria.
• May require adjustment of anticoagulant dose.
• To minimize gastrointestinal side effects, take with food.
• May predispose women to vaginal yeast infections.
• Do not use during pregnancy or while breastfeeding.
• Do not use if you are hypersensitive to any tetracycline.
• Do not use if you are allergic to sulfites.
• This drug may increase Digoxin absorption, and digitalis intoxication may result.
• Do not use if you have myasthenia gravis.
• Do not use for children under age 8 years.
• Pediatric dose: two mg/kg of body weight per day up to the adult dose of 100 mg/day.
• Do not take with milk or antacids.
• Swallow with adequate amounts of fluids to avoid the risk of esophageal irritation and ulceration.
• To further reduce the risk of esophagitis, do not take the drug at bedtime.
• Be careful out in the sun when you take this drug; you can develop a photosensitive rash.
• Used only for prevention of malaria, not treatment.
• Start one day before entering a malarious area.
• Take 100 mg. daily, and continue for 4 weeks after leaving a malarious area.
• According to the manufacturer, do not use for more than 4 months.
• For "standby treatment" of travelers on doxycycline, physicians may prescribe Fansidar.
  Dosage recommendations, contraindications, length of treatment, and possible side effects must be determined by a health care provider on an individual basis.

IMODIUM® AD (Loperamide Hcl), capsule or liquid without prescription, or IMODIUM®, 2 mg capsules by prescription

• For treatment of moderate travelers' diarrhea.
• The cornerstone of treatment for acute travelers' diarrhea in children is oral rehydration therapy (ORT). This drug only supplements ORT, and its effectiveness is unpredictable in children.
• Used as an anti-motility drug to stop the rapid discharge of stool.
• Don't use if you have bloody stools or a fever.
• Don't use if symptoms persist for more than 48 hours.
• May be used in conjunction with Bactrim DS (or Septra DS) for moderate diarrhea. Don't use with severe diarrhea associated with fever or bloody stools.
• Adult dosage: two capsules immediately for diarrhea, then one after each bowel movement. Do not exceed 8 capsules in 24 hours.
• If there is no fever or there are no bloody stools, you may take two tablets, immediately, accompanied by Noroxin® or Cipro®, as a single-dose alternative.
• Pediatric dose: 13-20 kg, one mg (5cc or one teaspoon) 3 times a day; 20-30 kg, two mg (10cc or two teaspoons) twice a day; 30 kg or more, two mg 3 times a day up to age 12. (See below.) · Not to be used by children under age 2 years.
• In children under age 13, use only the liquid form.
• Per the World Health Organization, anti-motility agents such as this are not to be used by children.
  Dosage recommendations, contraindications, length of treatment, and possible side effects must be determined by a health care provider on an individual basis.

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LARIAM® (Mefloquine Hydrochloride), 250 mg. Trade names in other countries include: Eloquin, Mephaquin, Mefque and Mefquin

• For malaria prevention and treatment.
• Requires a prescription in USA and Canada.
• Effective for prevention of chloroquine-sensitive and chloroquine-resistant P. falciparum or for P. vivax.
• Keep out of reach of children. Overdose can be fatal.
• Not recommended for travelers with a history of epilepsy, underlying cardiac conduction abnormalities, or psychiatric disorders.
• May be used in patients taking beta blockers if they have no underlying arrhythmia.
• Not to be used with chloroquine, quinine, quinidine, halofantrine, tricyclic antidepressants, anti-convulsants or protease inhibitors.
• Side effects include dizziness, hallucinations, headache, muscle pain, nausea, vomiting, nightmares, sleep disturbances, and loose stools. Recent reports have suggested that severe neurological and psychological reactions may be associated with its use. Travelers involved with tasks requiring fine coordination and spatial discrimination (e.g. airline crews, surgeons, and scuba divers) should not use this drug.
• If psychological signs such as anxiety, depression, irritability, paranoia or confusion are noted, discontinue the drug.
• Take one tablet weekly beginning one week before departure; one tablet weekly while in a malarious area, then one tablet every week for 4 additional weeks after leaving the malarious area.
• Do not take on an empty stomach. Take with 8 oz of water.
• Administration of prophylactic mefloquine should be separated from oral typhoid vaccine by at least 24 hours. (WHO recommends 3 days).
• Travelers with liver disease may eliminate the drug slower than normal.
• Pediatric dose (USPS): 4.6 mg/kg base (5 mg/kg salt) for infants under 15 kg (30 lbs); 1/4 tab for those weighing 15-19 kg (30-40 lbs); 1/2 tab from 20-30 kg (40-60 lbs); and 3/4 tab from 31-45 kg (60-90 lbs).
• Per CDC and FDA, it is approved for infants under 30 lbs when travel to a chloroquine-resistant area is unavoidable.
• Per WHO, not recommended for infants under 5 kg.
• Per WHO, parents are warned against taking babies and young children on holiday to malarious areas where transmission of chloroquine-resistant P. falciparum occurs.
• Per CDC, approved for use during pregnancy for women traveling to areas with chloroquine-resistant malaria.
• Per WHO, mefloquine may be taken only during the 2nd and 3rd trimester of pregnancy.
• Per WHO, pregnant women are advised not to travel on vacation to areas where transmission of chloroquine-resistant P. falciparum occurs.
• Per WHO, non-pregnant women who have pregnancy potential should avoid pregnancy while taking mefloquine and for 3 months after taking mefloquine.
• Generally considered safe when taken regularly for prevention for as long as one year.
• When used for prolonged periods, eye examinations and liver function tests are recommended.
• Per WHO, "Standby treatment" dose: two tablets in one dose, followed by two tablets after 8-12 hours. Reduce the second dose to one tablet for adults weighing less than 60 kg (132 lbs).
• Check http://lariaminfo.homestead.com for further information on mefloquine.
  Dosage recommendations, contraindications, length of treatment, and possible side effects must be determined by a health care provider on an individual basis.

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MALARONE® (Atovaquone 250 mg and Proguanil Hcl 100 mg); Pediatric formulation is Atovaquone 62.5 mg and Proguanil Hcl 25 mg

• For malaria prevention and treatment.
• Requires a prescription in USA and Canada.
• Effective for prevention and treatment of acute, uncomplicated P. falciparum malaria.
• Approved for children weighing more than 22 lbs. (10 kg.)
• Not approved for use in pregnancy.
• If used with tetracycline, metoclopramide (e.g., Reglan®), or rifampin it may not be effective.
• Malarone® should not be administered for at least 10 days after the last dose of oral typhoid vaccine.
• This drug should be used with caution in patients with severe kidney disease.
• Take the drug at the same time each day with food or a milky drink.
• If vomiting occurs within 1 hour of a dose, repeat the dose.
• Adult dosage (pre-travel): one tablet daily starting 1 - 2 days prior to entering a malaria area, one tablet daily while in the malaria area, and continuing daily for 7 days after leaving the malaria area.
• Pediatric dosage (pre-travel): based on body weight: 11 - 20 kg. use 1 pediatric tablet daily; 21 -30 kg. use 2 pediatric tablets daily; 31 - 40 kg. use 3 pediatric tablets daily; more than 40 kg. use 1 adult tablet.
• Malarone® tablets (pediatric) may be crushed and administered in food or milky drink.
• Malarone® may be used for presumptive self-treatement in persons suspected to have malaria, especially in the Amazon Basin of S. America, Southeast Asia, Kenya, Malawi, Mozambique, South Africa, Tanzania and Uganda.
• Dosage for self-treatment (sometimes called "standby" treatment): 4 adult tablets (as a single dose) daily for three consecutive days.
• Self-treatment only to be initiated if there is not another cause for the fever, you can't reach a medical facility for 24 hours, and you have been in the malaria area for at least 6 days.
• Take at the same time each day with food or a milky drink.
• Side effects may include headache, diarrhea, nausea, mouth ulcers, and abdominal pain. The drug is excreted through the kidney and should be taken cautiously by patients with kidney disease.
  Dosage recommendations, contraindications, length of treatment, and possible side effects must be determined by a health care provider on an individual basis.

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• A fluoroquinolone antibiotic.
• Requires a prescription in USA and Canada.
• Used for severe travelers' diarrhea with fever, chills, bloody stools, and severe cramping.
• Not to be used by pregnant women, nursing mothers, or adolescents under 18 years of age.
• Use 1 tablet twice a day for 3 days.
• If there is no fever or there are no bloody stools, you may take two tablets, immediately, accompanied by Imodium® AD, as a single-dose alternative for severe diarrhea.
• Recommended to be taken 1 hour before or 2 hours after eating.
• Do not use with anticoagulants, e.g., coumadin.
• Do not take with milk, yogurt, antacids or theophylline.
• Do not use with Carafate® (sucralfate), Septra DS (or Bactrim DS) or other antibiotics.
• May cause nausea, diarrhea, headaches, dizziness, or lightheadedness.
• May cause photosensitivity reaction if patients are exposed to excessive sunlight or artificial ultraviolet light. Discontinue this drug if phototoxicity occurs.
• Discontinue immediately if a skin rash or other allergic reactions occur.
• Discontinue immediately if muscle pain, inflammation or tendon rupture occurs.
• May also be used for some sinus infections, some infections of the kidneys or bladder, prostatitis, or uncomplicated gonorrhea.
  Dosage recommendations, contraindications, length of treatment, and possible side effects must be determined by a health care provider on an individual basis.

XIFAXAN™ (Rifaximin), 200 mg. Tablets

• A targeted intestinal antibiotic that is not absorbed into the body.
• Take 1 tablet, 3 times a day, for 3 days.
• May be taken with or without food.
• Indicated for the treatment of patients (>12 years of age) with travelers' diarrhea caused by noninvasive strains of E. coli. Generally this is a rapid onset, severe diarrhea.
• This drug should not be used in patients with diarrhea complicated by fever or blood in the stool or diarrhea due to organisms other than E. coli.
• May cause increased intestinal gas, headaches, abdominal pain, or rectal spasm, but the side effects are not different from a placebo.
• The tablets should be discontinued if symptoms (diarrhea, or bloody diarrhea) get worse or persist more than 24 - 48 hours.

ZITHROMAX ® (Azithromycin), 250 mg tablet; also available as an oral suspension.

• An antibiotic, available in tablet, or oral suspension, for use against mild to moderate infections, as well as severe travelers' diarrhea in children.
• Requires a prescription in USA and Canada.
• Do not use if you are taking mefloquine.
• Do not use if you are allergic to erythromycin.
• Like any antibiotic, if you start this drug, complete the course of therapy.
• Usual dose for mild to moderate infections: 500 mg the first day followed by a single 250 mg tablet daily for 4 days.
• Pediatric dose (for severe diarrhea): 10-12 mg/kg as a single dose on the first day, followed by 5-6 mg/kg on day 2-5.
• Tablets may be taken any time, including before or after eating.
• Oral suspension should be taken without food.
• A good antibiotic for all respiratory infections, some skin infections, and urethritis and cervicitis due to Chlamydia trachomatis or N. gonorrhoeae.
• Side effects include nausea, vomiting, diarrhea, or abdominal pain and, rarely, swelling and allergic reactions.
  Dosage recommendations, contraindications, length of treatment, and possible side effects must be determined by a health care provider on an individual basis.

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Based on: CDC, Health Information for International Travel 2008 , DHHS, Atlanta, GA, 2008; Physicians Desk Reference, 2008, Medical Economics Company, Montvale, NJ; and Dr. Richard Thompson's book Well on the Road - A Practical Guide for the International Traveler, 2008.