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Personal Protection Against Malaria
• avoidance of exposure to mosquitoes at their
peak feeding times (usually dusk and dawn) and
throughout the night
• use of insect repellents containing DEET (10–35%)
or picaridin (7%; if DEET is unacceptable),suitable
clothing, and insecticide-impregnated bed nets or
other materials
– Widespread use of bed nets treated with residual
pyrethroids reduces the incidence of malaria in areas
where vectors bite indoors at night
Table 203-8 Drugs Used in the Prophylaxis of Malaria
Drug
Usage
Atovaquone/proguani Prophylaxis in areas with
l (Malarone)
chloroquine- or mefloquineresistant Plasmodium
falciparum
Adult Dose
Comments
1 adult tablet PO
Good for last-minute travelers; 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. Side effects are uncommon. Contraindicated in
persons with severe renal impairment (creatinine clearance rate <30 mL/min).
It is not recommended for children weighing <5 kg, pregnant women, or
women breast-feeding infants weighing <5 kg. Should be taken with food or a
milky drink.
Chloroquine
phosphate (Aralen
and generic)
Prophylaxis only in areas with 300 mg of base
chloroquine-sensitive P.
(500 mg of salt)
c
falciparum
PO 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. Can be given in all trimesters of pregnancy. Patients taking
hydroxychloroquine for rheumatologic conditions may not need to take an
extra drug. May exacerbate psoriasis.
Doxycycline (many
brand names and
generic)
Prophylaxis in areas with
chloroquine- or mefloquineresistant P. falciparumc
•Good for last-minute travelers; begin 1–2 days before travel to malarious
areas. Least expensive among anti-malarial agents. Take daily at the same time
each day while in the malarious areas and for 4 weeks after leaving such areas.
Patients taking this for acne do not need to take an extra drug. Doxycycline also
can prevent some additional infections (e.g., Rickettsiae and leptospirosis) and
so it may be preferred by people planning to do lots of hiking, camping, and
wading and swimming in fresh water. Doxycycline is contraindicated in children
<8 years of age and in pregnant women. Women prone to getting vaginal yeast
infections when taking antibiotics may prefer taking a different medicine. Risk
of photosensitivity.
100 mg PO qd
Harrison’s Internal Medicine, 17th ed.
Global Health – Division of Parasitic Diseases. Centers for Disease Control and
Prevention, updated Feb. 8, 2010.
Hydroxychloroquine
sulfate (Plaquenil)
An alternative to chloroquine for
primary prophylaxis only in areas
with chloroquine-sensitive P.
falciparumc
310 mg of base
Begin 1–2 weeks before travel to malarious areas. Take weekly on
(400 mg of salt) PO the same day of the week while in the malarious areas and for 4
once weekly
weeks after leaving such areas. Hydroxychloroquine may exacerbate
psoriasis.
Mefloquine (Lariam
and generic)
Prophylaxis in areas with
228 mg of base
Begin 1–2 weeks before travel to malarious areas. Take weekly on
chloroquine-resistant P. falciparum (250 mg of salt) PO the same day of the week while in the malarious areas and for 4
once weekly
weeks after leaving such areas. Can be used in second and third
trimester of pregnancy, also in first if there is no other option.
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
An option for prophylaxis in special
circumstances; 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
Good for last-minute travelers; 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. This therapy
is indicated for persons who have had prolonged exposure to P.
vivax and/or P. ovale. It is the most effective medicine for preventing
P. vivax and so it is a good choice for travel to places with > 90% P.
vivax. Primaquine is contraindicated in persons with G6PD1
deficiency. It is also contraindicated during pregnancy and in
lactation unless the infant being breast-fed has a documented
normal G6PD level. Use in consultation with malaria experts.
Harrison’s Internal Medicine, 17th ed.
Global Health – Division of Parasitic Diseases. Centers for Disease Control
and Prevention, updated Feb. 8, 2010.