Drugs Used to Prevent Malaria
Druga | Use | Adult Dosage | Pediatric Dosage | Comments |
|---|---|---|---|---|
Atovaquone/proguanilAtovaquone/proguanilb | In all areas | 1 adult tablet once a day | 5–8 kg: one-half pediatric tablet once a day > 8–10 kg: three-fourths pediatric tablet once a day > 10–20 kg: 1 pediatric tablet once a day > 20–30 kg: 2 pediatric tablets once a day > 30–40 kg: 3 pediatric tablets once a day > 40 kg: 1 adult tablet once a day | Begun 1 to 2 days before travel and continued daily during the stay and for 7 days after leaving |
ChloroquineChloroquine | Only in areas with chloroquine-sensitive Only in areas with chloroquine-sensitivePlasmodium | 500 mg once a week | 8.3 mg/kg, up to maximum 500 mg once a week | Begun 1–2 weeks before travel and continued weekly during the stay and for 4 weeks after leaving |
Doxycycline Doxycyclinec | In all areas | 100 mg once a day | ≥ 8 years: 2.2 mg/kg (up to 100 mg) once a day | Begun 1–2 days before travel and continued during the stay and for 4 weeks after leaving |
Hydroxychloroquine Hydroxychloroquined | An alternative to chloroquine only in areas with chloroquine-sensitive An alternative to chloroquine only in areas with chloroquine-sensitivePlasmodium | 400 mg once a week | 6.5 mg/kg, up to 400 mg once a week | Begun 1–2 weeks before travel and continued during the stay and for 4 weeks after leaving |
Mefloquine Mefloquinee | In areas with mefloquine-sensitive In areas with mefloquine-sensitivePlasmodium | 250 mg once a week | ≤ 9 kg: 5 mg once a week > 9–19 kg: one-fourth tablet once a week > 19–30 kg: one-half tablet once a week > 30–45 kg: three-fourths tablet once a week > 45 kg: 1 tablet once a week | Begun ≥ 2 weeks before travel and continued during the stay and for 4 weeks after leaving Contraindicated in patients with a history of depression, other psychologic problems, or seizures; not recommended for patients with cardiac conduction abnormalities |
Primaquine Primaquinef | For primary prophylaxis for brief travel in areas known to harbor mainly P. vivax | 52.6 mg once a day | 0.8 mg/kg up to adult dose once a day | Begun 1 to 2 days before travel and continued daily during the stay and for 7 days after departure Document that the G6PD level is normal before use Contraindicated in people with G6PD deficiency and in pregnant and breastfeeding women unless the breastfed infant has a normal G6PD level |
For terminal prophylaxis to prevent relapse of infection in people with substantial exposure to or infection with P. vivax or P. ovale during travel | Dosed as above | Dosed as above | Given daily for 14 days after departure from endemic area. Document that the G6PD level is normal before use Contraindications as above | |
TafenoquineTafenoquine | For primary prophylaxis in travelers to all areas | 200 mg once a day for 3 days before travel as a loading regimen, then 200 mg once weekly for maintenance while in the malaria region starting 7 days after the last loading dose, then a 200 mg final dose after exit 7 days following the last maintenance dose | For patients ≥ 16 years | G6PD deficiency or unknown G6PD status; all patients should be tested for G6PD deficiency prior to use Pregnant and breastfeeding women unless the breastfed infant has a normal G6PD level; known hypersensitivity Psychiatric adverse reactions have been observed Use with caution in patients with a history of psychiatric illness |
For terminal prophylaxis in people with substantial exposure to or infection with P. vivax or P. ovale during travel | 300 mg single dose | Not for patients < 18 years | ||
a Preventive drugs are given orally. See table Adverse Reactions and Contraindications of Antimalarial Drugs for adverse reactions and contraindications. | ||||
b Atovaquone/proguanil is available as a fixed-dose combination tablet: adult tablets (250 mg atovaquone/100 mg proguanil) and pediatric tablets (62.5 mg atovaquone/25 mg proguanil). To enhance absorption, patients should take the drug with food or a milky drink. Atovaquone/proguanil is contraindicated in patients with a creatinine clearance < 30 mL/min. This combination is not recommended for children weighing < 5 kg or for pregnant or breastfeeding women.Atovaquone/proguanil is available as a fixed-dose combination tablet: adult tablets (250 mg atovaquone/100 mg proguanil) and pediatric tablets (62.5 mg atovaquone/25 mg proguanil). To enhance absorption, patients should take the drug with food or a milky drink. Atovaquone/proguanil is contraindicated in patients with a creatinine clearance < 30 mL/min. This combination is not recommended for children weighing < 5 kg or for pregnant or breastfeeding women. | ||||
c Use of tetracyclines is contraindicated during pregnancy and in children < 8 years. | ||||
d Physicians should review the prescribing information for hydroxychloroquine before using it.Physicians should review the prescribing information for hydroxychloroquine before using it. | ||||
e Mefloquine has not been approved for use during pregnancy. The drug is contraindicated in patients who have active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures; if patients have psychiatric disturbances or a previous history of depression, the drug should be used cautiously. The drug is not recommended for patients with cardiac conduction abnormalities.Mefloquine has not been approved for use during pregnancy. The drug is contraindicated in patients who have active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures; if patients have psychiatric disturbances or a previous history of depression, the drug should be used cautiously. The drug is not recommended for patients with cardiac conduction abnormalities. | ||||
f Primaquine is used as terminal prophylaxis (radical cure) to reduce risk of relapse in people who have taken chloroquine, hydroxychloroquine, or a drug active against Primaquine is used as terminal prophylaxis (radical cure) to reduce risk of relapse in people who have taken chloroquine, hydroxychloroquine, or a drug active againstchloroquine-resistant malaria as treatment or prophylaxis for prolonged exposure to P. vivax and/or P. ovale. Alternatively, a single dose of tafenoquine can be used in patients who have received chloroquine for . Alternatively, a single dose of tafenoquine can be used in patients who have received chloroquine forP. vivax treatment or prophylaxis. Primaquine or tafenoquine alone can also be used for primary prophylaxis in people at risk of malaria, particularly that due to treatment or prophylaxis. Primaquine or tafenoquine alone can also be used for primary prophylaxis in people at risk of malaria, particularly that due toP. vivax. Primaquine and tafenoquine are contraindicated in people with G6PD deficiency and in pregnant or breastfeeding women (unless the breastfed infant has a normal G6PD level).. Primaquine and tafenoquine are contraindicated in people with G6PD deficiency and in pregnant or breastfeeding women (unless the breastfed infant has a normal G6PD level). | ||||
G6PD = glucose-6-phosphate dehydrogenase. | ||||
Adapted from the Centers for Disease Control and Prevention Yellow Book: Infectious diseases related to travel: Malaria. | ||||