Malaria Chemoprophylaxis

1. See Also
   1. Malaria
   2. Prevention of Vector-borne Infection
2. General
   1. Always check CDC for resistance before prescribing
      1. CDC Travelers Health for regional recommendations
         1. http://www.cdc.gov/travel
   2. Chemoprophylaxis is for prevention only
      1. Dosing below does not apply to Malaria treatment
   3. Chemoprophylaxis Schedule
      1. Agents are started 1-2 weeks before travel
      2. Agents are continued for 4 weeks after travel
3. Prevention: First-Line Chemoprophylaxis
   1. Indications (Areas of no Chloroquine Resistance)
      1. Mexico
      2. Caribbean
      3. Central America
      4. Argentina
      5. Some areas in Middle East
      6. Some areas of China
   2. Chloroquine (Aralen)
      1. Adult: 500 mg (300 mg base) PO weekly
      2. Child: 8.3 mg/kg (5 mg/kg of base) PO weekly
4. Prevention: Second-line chemoprophylaxis (if No Mefloquine resistance)
   1. Indications
      1. Chloroquine resistance
      2. Safe in pregnancy
   2. Contraindications (relative)
      1. Seizure disorder
      2. Cardiac conduction abnormality
      3. Psychosis
   3. Mefloquine (Lariam)
      1. Adult: 250 mg (228 mg base) PO weekly
      2. Child: See Mefloquine for pediatric dosing
5. Prevention: Third-Line Chemoprophylaxis
   1. Indications
      1. Short term travel to Chloroquine resistance areas
      2. Mefloquine resistance areas
         1. Thailand - Cambodia border
         2. Thailand - Myanmar (Burma) border
   2. Contraindications
      1. Lactating women
      2. Children under age 8 years
   3. Doxycycline (Vibramycin)
      1. Adult Dosing: 100 mg PO qd
      2. Pediatric Dosing (may use if older than age 8)
         1. Dose: 2 mg/kg/day up to 100 mg qd
6. Prevention: Terminal Chemoprophylaxis
   1. Indications (on leaving endemic area)
      1. Prolonged exposure to P. vivax or P. ovale
      2. Taken for 14 days on leaving endemic area
   2. Contraindications
      1. Pregnancy
      2. G6PD Deficiency
   3. Adult dose
      1. Primaquine 26.3 mg PO qd for 14 days
7. Prevention: Chemoprophylaxis with other agents (adult dosing)
   1. Atovaquone/Proguanil (Malarone) 250/100 mg PO qd
   2. Azithromycin (Zithromax) 250 mg PO qd
   3. Tafenoquine (Etaquine) 250 mg PO weekly
   4. Pyrimethamine with sulfadoxine (Fansidar)
8. References
   1. Gilbert (2001) Sanford Guide, p. 88
   2. Kain (2001) Clin Infect Dis 33:226-34
   3. Lo Re (2003) Am Fam Physician 68(3):509-16