Treatment Options, Dosing and Counseling

Question 1

Malaria Prevention

Answer 1

Atovaquone 250mg / Proguanil 100mg (Malarone)
* Take 1 tablet everyday
* Start 1-2 days before the place of travel, take everyday during the trip and 7 days after the trip
* Avoid use in CrCL < 30 mL/min

Non-pharmacologicals:
* Use DEET mosquito repellent
* Wear long sleeve clothing

Question 2

Traveler’s Diarrhea

Answer 2

Antimotility Agents:
1. Loperamide 2 mg Capsules
* Take 2 capsules after first sign of loose stools and then take 1 capsule after every subsequent loose stools (Age ≥ 12 years old)
* Maximum dose: 16 mg/day (8 capsules)
* For ages 6-12 years old, maximum dose is 3 capsules per 20 kg body weight

2. Diphenoxylate 2.5 mg / Atropine 0.025 mg Tablets
   * Take 2 tablets four times a day
   * Maximum dose: 20 mg/day
3. Diocthedral Smectite 3g (Smecta)
   * 1 sachet TDS for 7 days (3 sachet/day)
4. Activated/Medicinal Charcoal 250 mg:
   * 2-4 tabs TDS

Question 3

Antispasmodic and antiflatulent Agents

Answer 3

1. Hyoscine Butylbromide 10 mg (Buscopan)
   * Take 1 to 2 tablets 3-5 times a day
   * Age > 6 years old
2. Alverine/Simethicone 60/300 mg (Alversime)
   * Take 1 capsule 3 times a day
   * Adults
3. Dicyclomine Hydrochloride 5mg/5ml with Simethicone 50mg/5ml (Colimix)
   * Take 10 mL four times a day (Adult)
   * For children 4-12 years: 5-10 mL four times a day
   * Infants > 6 months: 5 mL four times a day

Question 4

Motion Sickness

Answer 4

1. Cinnarizine 25 mg Tablets
   * Take 1 tablet 30 min before travel, can repeat after every 6 hours
2. Dimenhydrinate 50 mg Tablets
   * Take 1 or 2 tablets 30 min before travel, can repeat after every 6 to 8 hours (Max: 400 mg/day)
3. Diphenhydramine
   * Take 25-50 mg 30 min before travel, can repeat every 4 to 6 hours (Max: 300 mg/day)
4. Promethazine
   * Take 25 mg 30-60 min before travel, can repeat every 12 hours when needed
5. Chlorpheniramine 4 mg Tablets
   * Take 1 tablet every 4 to 6 hours

Common Side Effects
* Drowsiness
* Dry mouth, constipation, urinary retention