COMDTINST 6230.5A
6 DEC 1993
(2)
Mefloquine should be used as an alternative therapy for those patients unable to
take Doxycycline. Recommended treatment is 250 mg once weekly during malaria
exposure, continued once weekly four weeks post exposure.
(3)
Terminal prophylaxis with primaquine should be given for those with prolonged
exposure to vivax or ovale malaria (see 7.a.(2) above).
(4)
Personnel on flight status shall not be given Mefloquine due to its common side
effects (dizziness, nausea, etc.). A 3 day trial period of doxycycline should be
considered prior to flying, to preclude effects which may be detrimental to flight
safety.
(5)
Pregnant personnel shall receive chloroquine prophylaxis even for areas of
chloroquine resistance. Mefloquine, primaquine, and doxycycline should not be
used during pregnancy. Chemoprophylaxis for pregnant personnel requires careful
consideration and thorough consultation.
8.
DIAGNOSIS OF MALARIA. Malaria should be suspected in any illness characterized by
periodic chills and fevers among personnel who visit malaria-risk areas. The triad of headache,
backache, and fever with or without chills is the common symptom complex in these
individuals. Furthermore, in exposed persons, delirium, coma, or shock should immediately
suggest the possibility or malaria. Even in severe cases, the temperature may be subnormal.
Other previous diagnosis should not be allowed to mislead the observer. Clinical attacks may
recur after treatment or the initial evidence of disease may appear weeks after discontinuing
chemoprophylaxis. In summary, whenever personnel who travel to malaria-risk areas exhibit
illness, the possibility of malaria should be considered. For additional information on
symptoms of malaria, contact either the Centers for Disease Control at (404) 488-4046 or
Commandant (G-KOM) at (202) 267-0692.
9.
TREATMENT OF MALARIA. Once the diagnosis of malaria is suspected or confirmed, the
patient must be taken to the nearest physician-staffed medical facility for the initiation of
treatment.
10. RESPONSIBILITIES.
a.
Commandant (G-KOM). Provide policy guidance for malaria prevention and control.
This includes recommended chemoprophylaxis, treatment protocols, medical evaluation
procedures, personnel protective measures, and vector control methods.
4