Drugs Used in the Prophylaxis of Malaria
| Drug | Usage | Adult Dose | Pediatric Dose | Comments |
|---|---|---|---|---|
| Atovaquone-proguanil (Malarone) | Prophylaxis in areas with chloroquine- or mefloquine-resistant Plasmodium falciparum | One adult tablet POa | 5-8 kg: ½ pediatric tabletb daily ≥8-10 kg: ¾ pediatric tablet daily ≥10-20 kg: One pediatric tablet daily ≥20-30 kg: Two pediatric tablets daily ≥30-40 kg: Three pediatric tablets daily ≥40 kg: One adult tablet daily | Begin 1-2 days before travel to malarious areas. Take daily at the same time each day while in the malarious areas and for 7 days after leaving such areas. Atovaquone-proguanil is contraindicated in persons with severe renal impairment (creatinine clearance rate <30 mL/min). In the absence of data, it is not recommended for children weighing <5 kg, pregnant women, or women breast-feeding infants weighing <5 kg. Atovaquone-proguanil should be taken with food or a milky drink. |
| Chloroquine phosphate (Aralen and generic) | Prophylaxis only in areas with chloroquine-sensitive P. falciparumc or areas with P. vivax only | 300 mg of base (500 mg of salt) PO once weekly | 5 mg/kg of base (8.3 mg of salt/kg) PO once weekly, up to maximum adult dose of 300 mg of base | Begin 1-2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious areas and for 4 weeks after leaving such areas. Chloroquine phosphate may exacerbate psoriasis. |
| Doxycycline (many brand names and generic) | Prophylaxis in areas with chloroquine- or mefloquine-resistant P. falciparumc | 100 mg PO qd (except in pregnant women; see Comments) | ≥8 years of age: 2 mg/kg, up to adult dose | Begin 1-2 days before travel to malarious areas. Take daily at the same time each day while in the malarious areas and for 4 weeks after leaving such areas. Doxycycline is contraindicated in children <8 years of age and in pregnant women. |
| Hydroxychloroquine sulfate (Plaquenil) | An alternative to chloroquine for primary prophylaxis only in areas with chloroquine-sensitive P. falciparumc or areas with P. vivax only | 310 mg of base (400 mg of salt) PO once weekly | 5 mg of base/kg (6.5 mg of salt/kg) PO once weekly, up to maximum adult dose of 310 mg of base | Begin 1-2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious areas and for 4 weeks after leaving such areas. Hydroxychloroquine may exacerbate psoriasis. |
| Mefloquine (Lariam and generic) | Prophylaxis in areas with chloroquine-resistant P. falciparumc | 228 mg of base (250 mg of salt) PO once weekly | ≤9 kg: 4.6 mg of base/kg (5 mg of salt/kg) PO once weekly 10-19 kg: ¼ tablet once weekly 20-30 kg: ½ tablet once weekly 31-45 kg: ¾ tablet once weekly ≥46 kg: 1 tablet once weekly | Begin 1-2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious areas and for 4 weeks after leaving such areas. Mefloquine is contraindicated in persons allergic to this drug or related compounds (e.g., quinine and quinidine) and in persons with active or recent depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures. Use with caution in persons with psychiatric disturbances or a history of depression. Mefloquine is not recommended for persons with cardiac conduction abnormalities. |
| Primaquine | For prevention of malaria in areas with mainly P. vivax | 30 mg of base (52.6 mg of salt) PO qd | 0.5 mg of base/kg (0.8 mg of salt/kg) PO qd, up to adult dose; should be taken with food | Begin 1-2 days before travel to malarious areas. Take daily at the same time each day while in the malarious areas and for 7 days after leaving such areas. Primaquine is contraindicated in persons with G6PD deficiency. It is also contraindicated during pregnancy and in lactation unless the infant being breast-fed has a documented normal G6PD level. |
| Used for presumptive antirelapse therapy (terminal prophylaxis) to decrease risk of relapses of P. vivax and P. ovale | 30 mg of base (52.6 mg of salt) PO qd for 14 days after departure from the malarious area | 0.5 mg of base/kg (0.8 mg of salt/kg), up to adult dose, PO qd for 14 days after departure from the malarious area | This therapy is indicated for persons who have had prolonged exposure to P. vivax and/or P. ovale. It is contraindicated in persons with G6PD deficiency as well as during pregnancy and in lactation unless the infant being breast-fed has a documented normal G6PD level. |
aAn adult tablet contains 250 mg of atovaquone and 100 mg of proguanil hydrochloride.
bA pediatric tablet contains 62.5 mg of atovaquone and 25 mg of proguanil hydrochloride.
cVery few areas now have chloroquine-sensitive malaria (Fig. 248-2 in HPIM-19).
Source: CDC: www.cdc.gov/malaria/travelers/drugs.html.