Chimioprophylaxie du paludisme: vers une harmonisation européenne

Multi-facetted control efforts against malaria in endemic areas have led in the last decade to a sizeable decrease in its prevalence and incidence in almost all tropical regions. A parallel decline of the number of malaria cases in returning travelers is being observed, even if this trend is not so spectacular after a stay in West or Central Africa. This fast evolution should question the need of systematic chemoprophylaxis for all short-term travelers going to the tropics, in particular to very low risk areas of Southern Asia or Latin America. Surprisingly both North American and European guidelines diverge substantially regarding the indications of chemoprophylaxis according to the geographic risk, with more or less liberal recommendations, often not strongly supported. A neutral comparison between the low risk of contracting a potentially severe (P. falciparum) malaria in most Asian or Latin American regions with the very limited but "uncompressible" risk of severe drug toxicity should lead to a decrease in unnecessary prescriptions based on erroneous feelings rather than robust evidence. An harmonization of the European recommendations is highly desirable for this mobile and informed population. Intermediate or alternative preventive strategies should be also be explored.