Malaria chemoprophylaxis: Difference between revisions

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== Background ==
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* Chemoprophylaxis is recommended for travelers to endemic areas
  
⚫
* Agent chosen based on the local drug-resistance, patient age, and pregnancy status
  
   
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== 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===
⚫
{| class="wikitable"
  
  +
−
! Medication !! Dose !! Duration
  
  ⚫
*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
 
|-
  
|-
−
| [[Atovaquone-proguanil]] || 250 mg-100 mg po daily || 1 day before to 1 week after
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|[[Atovaquone-proguanil]]||250 mg-100 mg po daily||1 day before||1 week after
 
|-
  
|-
−
| [[Doxycycline]] || 100 mg po daily || 1 day before to 4 weeks after
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|[[Doxycycline]]||100 mg po daily||1 day before||4 weeks after
 
|-
  
|-
−
| [[Mefloquine]] || 250 mg po weekly || 1-3 weeks before to 4 weeks after
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|[[Mefloquine]]||250 mg po weekly||1-3 weeks before||4 weeks after
 
|-
  
|-
−
| [[Primaquine]] || 30 mg base po daily || 1 day before to 7 days after
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|[[Primaquine]]||30 mg base po daily||1 day before||1 week after
 
|-
  
|-
−
| [[Chloroquine]] || 300 mg po weekly || 1 week before to 4 weeks after
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|[[Chloroquine]]||300 mg po weekly||1 week before||4 weeks after
 
|-
  
|-
−
| [[Hydroxychloroquine]] || 310 mg base po weekly || 1 week before to 4 weeks after
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|[[Hydroxychloroquine]]||310 mg base po weekly||1 week before||4 weeks after
 
|}
  
|}
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[[Category:Travel medicine]]
−  
−
[[Category:Protozoa]]
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[[Category:Infectious diseases]]
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[[Category:Malaria]]

Latest revision as of 10:22, 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

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

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

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
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