Safety of antimalarial medications for use while scuba diving in malaria Endemic RegionsReport as inadecuate

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Tropical Diseases, Travel Medicine and Vaccines

, 2:23

First Online: 11 October 2016Received: 20 April 2016Accepted: 07 October 2016


BackgroundRecreational diving occurs annually in areas of the world where malaria is endemic. The safety and efficacy of antimalarials for travelers in a hyperbaric environment is unknown. Of particular concern would be medications with adverse effects that could either mimic diving related illnesses such as barotrauma, decompression sickness DCS and gas toxicities, or increase the risk for such illnesses.

MethodsWe conducted a review of PubMed and Cochrane databases to determine rates of neurologic adverse effects or other effects from antimalarials that may be a problem in the diving environment.

ResultsOne case report was found on diving and mefloquine. Multiple case reports and clinical trials were found describing neurologic adverse effects of the major chemoprophylactic medications atovaquone-proguanil, chloroquine, doxycycline, mefloquine, and primaquine.

ConclusionsOf the available literature, atovaquone-proguanil and doxycycline are most likely the safest agents and should be preferred; atovaquone-proguanil is superior due to reduced rates of sunburn in the marine environment. Primaquine also appears to be safe, but has reduced efficacy against P. falciparum; mefloquine possesses the highest rate of neurologic side effects and therefore these agents should be limited to extreme cases of patients intolerant to other agents. Chloroquine appears unsafe in the hyperbaric environment and should be avoided. More studies are required to include database reviews of returned divers traveling to malaria endemic areas and randomized controlled trials in the hyperbaric environments.

KeywordsSCUBA diving Diving Malaria Prophylaxis Chemoprophylaxis AbbreviationsA-P:Atovaquone-proguanil

CNSCentral nervous system

DCSDecompression Sickness

SCUBASelf-contained underwater breathing apparatus.

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Author: Kyle Petersen - David P. Regis


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