Malaria chemoprophylaxis: Difference between revisions

Latest revision as of 14:22, 1 October 2020

Background

Chemoprophylaxis is recommended for travelers to endemic areas
Agent chosen based on the local drug-resistance, patient age, and pregnancy status
Also need to focus on personal protective measures such as bed nets, long-sleeved clothing, and insect repellant

Chemoprophylaxis Selection

Chloroquine-Sensitive Regions

Regions include Haiti, the Dominican Republic, Central America north of the Panama Canal, parts of Mexico, parts of South America, north Africa, parts of the Middle East, and west/central China
- See the CATMAT list for specific countries
Drugs of choice
- Chloroquine (Aralen) preferred, though hydroxychloroquine (Plaquenil) is also acceptable
- Alternatives: atovaquone-proguanil, doxycycline, or mefloquine

Chloroquine-Resistant Regions

Regions include most of sub-Saharan Africa, South America, Oceania and Asia
- See the CATMAT list for specific countries
- Some areas of Thailand, Myanmar (Burma), Laos and Cambodia, and southern Vietnam are both chloroquine-resistant and mefloquine-resistant
Drugs of choice
- Atovaquone-proguanil
- Doxycycline
- Mefloquine
- Alternatives: Primaquine (contraindicated in G6PD deficiency and pregnancy)

Chloroquine- and Mefloquine-Resistant Regions

Regions include Asia, Africa and the Amazon basin, specifically in rural, wooded regions on the Thai borders with Myanmar, Cambodia, and Laos, as well as in southern Vietnam
Drugs of choice
- Atovaquone-proguanil
- Doxycycline
- No approved drugs for pregnancy or children less than 5 kg, though atovaquone-proguanil may be considered after the first trimester

Pregnancy

Mefloquine can be used, if they cannot avoid travelling to malaria-endemic areas
- Can cause neuropsychiatric symptoms
Atovaquone-proguanil may be considered after the first trimester

Chemoprophylaxis Doses

Note that the medications that require 4 weeks after end of exposure are extended in this way because they do not treat the liver stage

Medication	Dose	Start	Stop
Atovaquone-proguanil	250 mg-100 mg po daily	1 day before	1 week after
Doxycycline	100 mg po daily	1 day before	4 weeks after
Mefloquine	250 mg po weekly	1-3 weeks before	4 weeks after
Primaquine	30 mg base po daily	1 day before	1 week after
Chloroquine	300 mg po weekly	1 week before	4 weeks after
Hydroxychloroquine	310 mg base po weekly	1 week before	4 weeks after

@@ Line 1: / Line 1: @@
+== Background ==
-* Chemoprophylaxis is recommended for travelers to endemic areas
-* Agent chosen based on the local drug-resistance, patient age, and pregnancy status
-== Chemoprophylaxis Selection ==
+*Chemoprophylaxis is recommended for travelers to endemic areas
+*Agent chosen based on the local drug-resistance, patient age, and pregnancy status
-=== Chloroquine-sensitive regions ===
+*Also need to focus on personal protective measures such as bed nets, long-sleeved clothing, and insect repellant
-* Regions include Haiti, the Dominican Republic, Central America north of the Panama Canal, parts of Mexico, parts of South America, north Africa, parts of the Middle East, and west/central China
-** See [https://www.canada.ca/en/public-health/services/travel-health/about-catmat/appendix-malaria-risk-recommended-chemoprophylaxis-geographic.html#tbl1 the CATMAT list] for specific countries
-* Drugs of choice
-** [[Chloroquine]] (Aralen) preferred, though [[hydroxychloroquine]] (Plaquenil) is also acceptable
-** Alternatives: [[atovaquone-proguanil]], [[doxycycline]], or [[mefloquine]]
+==Chemoprophylaxis Selection==
-=== Chloroquine-resistant regions ===
+===Chloroquine-Sensitive Regions===
-* Regions include most of sub-Saharan Africa, South America, Oceania and Asia
-** See [https://www.canada.ca/en/public-health/services/travel-health/about-catmat/appendix-malaria-risk-recommended-chemoprophylaxis-geographic.html#tbl1 the CATMAT list] for specific countries
-** Some areas of Thailand, Myanmar (Burma), Laos and Cambodia, and southern Vietnam are both chloroquine-resistant and mefloquine-resistant
-* Drugs of choice
-** [[Atovaquone-proguanil]]
-** [[Doxycycline]]
-** [[Mefloquine]]
-** Alternatives: [[Primaquine]] (contraindicated in G6PD deficiency and pregnancy)
+*Regions include Haiti, the Dominican Republic, Central America north of the Panama Canal, parts of Mexico, parts of South America, north Africa, parts of the Middle East, and west/central China
-=== Chloroquine-and mefloquine-resistant regions ===
+**See [https://www.canada.ca/en/public-health/services/travel-health/about-catmat/appendix-malaria-risk-recommended-chemoprophylaxis-geographic.html#tbl1 the CATMAT list] for specific countries
-* Regions include Asia, Africa and the Amazon basin, specifically in rural, wooded regions on the Thai borders with Myanmar, Cambodia, and Laos, as well as in southern Vietnam
-* Drugs of choice
+*Drugs of choice
+**[[Chloroquine]] (Aralen) preferred, though [[hydroxychloroquine]] (Plaquenil) is also acceptable
-** [[Atovaquone-proguanil]]
+**Alternatives: [[atovaquone-proguanil]], [[doxycycline]], or [[mefloquine]]
-** [[Doxycycline]]
-** No approved drugs for pregnancy or children less than 5 kg, though [[atovaquone-proguanil]] may be considered after the first trimester
+===Chloroquine-Resistant Regions===
-=== Pregnancy ===
-* [[Mefloquine]] can be used, if they cannot avoid travelling to malaria-endemic areas
-** Can cause neuropsychiatric symptoms
-* [[Atovaquone-proguanil]] may be considered after the first trimester
+*Regions include most of sub-Saharan Africa, South America, Oceania and Asia
-== Chemoprophylaxis Doses ==
+**See [https://www.canada.ca/en/public-health/services/travel-health/about-catmat/appendix-malaria-risk-recommended-chemoprophylaxis-geographic.html#tbl1 the CATMAT list] for specific countries
-* Note that the medications that require 4 weeks after end of exposure are extended in this way because they do not treat the liver stage
+**Some areas of Thailand, Myanmar (Burma), Laos and Cambodia, and southern Vietnam are both chloroquine-resistant and mefloquine-resistant
+*Drugs of choice
+**[[Atovaquone-proguanil]]
+**[[Doxycycline]]
+**[[Mefloquine]]
+**Alternatives: [[Primaquine]] (contraindicated in G6PD deficiency and pregnancy)
+===Chloroquine- and Mefloquine-Resistant Regions===
+*Regions include Asia, Africa and the Amazon basin, specifically in rural, wooded regions on the Thai borders with Myanmar, Cambodia, and Laos, as well as in southern Vietnam
+*Drugs of choice
+**[[Atovaquone-proguanil]]
+**[[Doxycycline]]
+**No approved drugs for pregnancy or children less than 5 kg, though [[atovaquone-proguanil]] may be considered after the first trimester
+===Pregnancy===
+*[[Mefloquine]] can be used, if they cannot avoid travelling to malaria-endemic areas
+**Can cause neuropsychiatric symptoms
+*[[Atovaquone-proguanil]] may be considered after the first trimester
+==Chemoprophylaxis Doses==
+*Note that the medications that require 4 weeks after end of exposure are extended in this way because they do not treat the liver stage
 {| class="wikitable sortable"
-! Medication               !! Dose                   !! Start            !! Stop
+!Medication!!Dose!!Start!!Stop
 |-
-| [[Atovaquone-proguanil]] || 250 mg-100 mg po daily || 1 day before     || 1 week after
+|[[Atovaquone-proguanil]]||250 mg-100 mg po daily||1 day before||1 week after
 |-
-| [[Doxycycline]]          || 100 mg po daily        || 1 day before     || 4 weeks after
+|[[Doxycycline]]||100 mg po daily||1 day before||4 weeks after
 |-
-| [[Mefloquine]]           || 250 mg po weekly       || 1-3 weeks before || 4 weeks after
+|[[Mefloquine]]||250 mg po weekly||1-3 weeks before||4 weeks after
 |-
-| [[Primaquine]]           || 30 mg base po daily    || 1 day before     || 7 days after
+|[[Primaquine]]||30 mg base po daily||1 day before||1 week after
 |-
-| [[Chloroquine]]          || 300 mg po weekly       || 1 week before    || 4 weeks after
+|[[Chloroquine]]||300 mg po weekly||1 week before||4 weeks after
 |-
-| [[Hydroxychloroquine]]   || 310 mg base po weekly  || 1 week before    || 4 weeks after
+|[[Hydroxychloroquine]]||310 mg base po weekly||1 week before||4 weeks after
 |}
+[[Category:Travel medicine]]
-[[Category:Protozoa]]
+[[Category:Infectious diseases]]
+[[Category:Malaria]]