MEDICATIONS - Medicine for Mountaineering and Other Wilderness Activities - page 524

Dose: 250 mg once weekly beginning one week before entering an area in which
chloroquineresistant falciparum malaria is known to exist, and continuing for four weeks
after leaving the area.
Malarone®
Malarone® is a combination of the antimalarial agents atovaquone and proguanil.
Malarone® is indicated for the prevention of falciparum malaria, including areas where
chloroquineresistancehasbeenreported.Itisalsousefulforthetreatmentofacute,uncom-
plicated falciparum malaria. Although no adequate, well-controlled studies of atovaquone
or proguanil in pregnant women have been performed, Malarone® may be used if the po-
tential benefit justifies the potential risk to the fetus.
Dose: Prophylactic treatment with one tablet daily started one or two days before enter-
ing a malaria endemic area and continued daily during the stay and for seven days upon
return.
ANTISEPTICS
Povidone-Iodine
Povidone-iodine,aniodophorandaloosecomplexofiodinewithpolyvinylpyrrolidone,
was patented in 1956 and subsequently has become widely available as a 10 percent solu-
tion under the trade names Betadine®, Povidine®, Pharmadine, and others. These prepar-
ations offer two significant advantages for wilderness use: They can be kept in polyethyl-
ene containers, which avoids glass containers, and they are effective disinfectants in dilute
solutions so that less must be carried.
Povidone-iodine retains the strong bactericidal activity of iodine but eliminates many
of the disadvantages, such as skin irritation, staining of the skin, and some of the odor. A
1:100 dilution of a 10 percent solution has been found to have much greater bactericidal
action than the original stock solution, and 1:1000 dilutions are almost equally effective.
Precautions: Rare individuals are allergic to iodine; a chronic skin rash is the usual
manifestation. Such individuals should not use povidone-iodine.
Povidone-iodine has been recommended for water disinfection, but no substantiating
data have been provided. The 1:10,000 dilution that would result has been found to have
no significant antimicrobial activity. At present, these agents cannot be considered reliable
for water disinfection.
Application: For skin disinfection prior to injections, the undiluted solution is suitable
and convenient. For rinsing a larger wound, the original solution should be diluted several
hundred times and the wound thoroughly rinsed with large quantities of the solution, par-
ticularly following the bite of a possibly rabid animal.