Generic substitution

TL;DR: High incidence of chloroquine resistance in malaria in the country necessitates the use of an effective prophylactic alternative. Maloprim or Fansidar is recommended.

Abstract: from the coast in search of work, returning home with Plasmodium falciparum malaria, which has about a 60%' chance of exhibiting at least Rl chloroquine resistance (Gibson FD. Eighth south west Pacific malaria conference. Port Moresby, Papua New Guinea, 4 August, 1980). Added to this it would be most unlikely that Dr Ree's patient would have remained in his eyrie without descending from time to time, as most expatriates do, to the coast, where non-immune and protected only perhaps by chloroquine he would be seriously at risk. The principle is surely that in a country with a known high incidence of chloroquine resistant malaria an effective alternative prophylactic should be taken wherever one is within that country. Maloprim is recommended at present,1 2 although if agranulocytosis proves to be more than an occasional complication then Fansidar (pyrimethamine and sulfadoxine) might be a safer choice.