Malaria chemoprophylaxis
From IDWiki
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 |
