Drugs use in the prophylaxis of malaria
DRUG | USAGE | ADULT DOSE | PEDIATRIC DOSE | COMMENTS |
|---|---|---|---|---|
Atovaquone-proguanil | Prophylaxis in all areas | Adult tablets contain 250 mg atovaquone and 100 mg proguanil hydrochloride. 1 adult tablet orally, daily | Pediatric tablets contain 62.5 mg atovaquone and 25 mg proguanil hydrochloride. 5–8 kg: 1/2 pediatric tablet daily >8–10 kg: 3/4 pediatric tablet daily >10–20 kg: 1 pediatric tablet daily >20–30 kg: 2 pediatric tablets daily >30–40 kg: 3 pediatric tablets daily >40 kg: 1 adult tablet daily | Begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious area and for 7 days after leaving such areas. Contraindicated in people with severe renal impairment (creatinine clearance <30 mL/min). Atovaquone-proguanil should be taken with food or a milky drink. Not recommended for prophylaxis for children weighing <5 kg, pregnant women, and women breastfeeding infants weighing <5 kg. Partial tablet doses may need to be prepared by a pharmacist and dispensed in individual capsules, as described in the text. |
Chloroquine phosphate | Prophylaxis only in areas with chloroquine-sensitive malaria | 300 mg base (500 mg salt) orally, once/week | 5 mg/kg base (8.3 mg/kg salt) orally, once/week, up to maximum adult dose of 300 mg base | Begin 1–2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious area and for 4 weeks after leaving such areas. May exacerbate psoriasis. |
Doxycycline | Prophylaxis in all areas | 100 mg orally, daily | ≥8 years of age: 2.2 mg/kg up to adult dose of 100 mg/day | Begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious area and for 4 weeks after leaving such areas. Contraindicated in children <8 years of age and pregnant women. |
Hydroxychloro- | An alternative to chloroquine for prophylaxis only in areas with chloroquine-sensitive malaria | 310 mg base (400 mg salt) orally, once/week | 5 mg/kg base (6.5 mg/kg salt) orally, once/week, up to maximum adult dose of 310 mg base | Begin 1–2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious area and for 4 weeks after leaving such areas. |
Mefloquine | Prophylaxis in areas with mefloquine-sensitive malaria | 228 mg base (250 mg salt) orally, once/week | ≤9 kg: 4.6 mg/kg base (5 mg/kg salt) orally, once/week >9-19 kg: 1/4 tablet once/week >19-30 kg: 1/2 tablet once/week >30-45 kg: 3/4 tablet once/week >45 kg: 1 tablet once/week | Begin ≥2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious area and for 4 weeks after leaving such areas. Contraindicated in people allergic to mefloquine or related compounds (quinine, quinidine) and in people with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures. Use with caution in persons with psychiatric disturbances or a previous history of depression. Not recommended for persons with cardiac conduction abnormalities. |
Primaquine 1 | Prophylaxis for short- duration travel to areas with principallyP.vivax | 30 mg base (52.6 mg salt) orally, daily | 0.5 mg/kg base (0.8 mg/kg salt) up to adult dose orally, daily | Begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious area and for 7 days after leaving such areas. Contraindicated in people with G6PD deficiency. Also contraindicated during pregnancy and lactation, unless the infant being breastfed has a documented normal G6PD level. |
| Used for presumptive antirelapse therapy (terminal prophylaxis) to decrease the risk for relapses ofP. vivax andP. ovale | 30 mg base (52.6 mg salt) orally, daily for 14 days after departure from the malarious area | 0.5 mg/kg base (0.8 mg/kg salt) up to adult dose orally, daily for 14 days after departure from the malarious area | Indicated for people who have had prolonged exposure to P. vivax, P. ovale, or both. Contraindicated in people with G6PD deficiency. Also contraindicated during pregnancy and lactation, unless the infant being breastfed has a documented normal G6PD level. |
Abbreviation: G6PD, glucose-6-phosphate dehydrogenase.
1All people who take primaquine should have a documented normal G6PD level before starting the medication.
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