Choosing a Drug to Prevent Malaria

 

Drug Reasons that might make you consider using this drug Reasons that might make you avoid using this drug
Atovaquone/Proguanil (Malarone)

Adults: 1 adult tablet daily.

Children: 5-8 kg: ½ pediatric tablet daily. 8-10 kg: ¾ pediatric tablet daily. 10-20 kg: 1 pediatric tablet daily. 20-30 kg: 2 pediatric tablets daily. 30-40 kg 3 pediatric tablets daily. 40 kg and over: 1 adult tablet daily. Begin 1-2 days before travel, daily during travel, and for 7 days after leaving.

  • Good for last-minute travelers because the drug is started 1-2 days before traveling to an area where malaria transmission occurs
  • Some people prefer to take a daily medicine
  • Good choice for shorter trips because you only have to take the medicine for 7 days after traveling rather than 4 weeks
  • Very well tolerated medicine – side effects uncommon
  • Pediatric tablets are available and may be more convenient
  • Cannot be used by women who are pregnant or breastfeeding a child less than 5 kg
  • Cannot be taken by people with severe renal impairment
  • Tends to be more expensive than some of the other options (especially for trips of long duration)
  • Some people (including children) would rather not take a medicine every day

Drug Reasons that might make you consider using this drug Reasons that might make you avoid using this drug
Chloroquine

Adults: 300 mg base (500 mg salt), once/week.

Children: 5 mg/kg base (8.3 mg/kg salt) (maximum is adult dose), once/week. Begin 1-2 weeks before travel, once/week during travel, and for 4 weeks after leaving.

  • Some people would rather take medicine weekly
  • Good choice for long trips because it is taken only weekly
  • Some people are already taking hydroxychloroquine chronically for rheumatologic conditions. In those instances, they may not have to take an additional medicine
  • Can be used in all trimesters of pregnancy
  • Cannot be used in areas with chloroquine or mefloquine resistance
  • May exacerbate psoriasis
  • Some people would rather not take a weekly medication
  • For trips of short duration, some people would rather not take medication for 4 weeks after travel
  • Not a good choice for last-minute travelers because drug needs to be started 1-2 weeks prior to travel

 

Drug Reasons that might make you consider using this drug Reasons that might make you avoid using this drug
Doxycycline

Adults: 100 mg daily.

Children: ≥8 years old: 2.2 mg/kg (maximum is adult dose) daily. Begin 1-2 days before travel, daily during travel, and for 4 weeks after leaving.

  • Some people prefer to take a daily medicine
  • Good for last-minute travelers because the drug is started 1-2 days before traveling to an area where malaria transmission occurs
  • Tends to be the least expensive antimalarial
  • Some people are already taking doxycycline chronically for prevention of acne. In those instances, they do not have to take an additional medicine
  • 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
  • Cannot be used by pregnant women and children <8 years old
  • Some people would rather not take a medicine every day
  • For trips of short duration, some people would rather not take medication for 4 weeks after travel
  • Women prone to getting vaginal yeast infections when taking antibiotics may prefer taking a different medicine
  • Persons planning on considerable sun exposure may want to avoid the increased risk of sun sensitivity
  • Some people are concerned about the potential of getting an upset stomach from doxycycline

 

Drug Reasons that might make you consider using this drug Reasons that might make you avoid using this drug
Mefloquine

Adults: 228 mg base (250 mg salt), weekly.Children: ≤9 kg: 4.6 mg/kg base (5 mg/kg salt), weekly. 10-19 kg: ¼ tablet weekly. 20-30 kg: ½ tablet weekly. 31-45 kg: ¾ tablet weekly. >45 kg: 1 tablet weekly. Begin 1-2 weeks before travel, weekly during travel, and for 4 weeks after leaving.

  • Some people would rather take medicine weekly
  • Good choice for long trips because it is taken only weekly
  • Can be used during pregnancy
  • Cannot be used in areas with mefloquine resistance
  • Cannot be used in patients with certain psychiatric conditions
  • Cannot be used in patients with a seizure disorder
  • Not recommended for persons with cardiac conduction abnormalities
  • Not a good choice for last-minute travelers because drug needs to be started at least 2 weeks prior to travel
  • Some people would rather not take a weekly medication
  • For trips of short duration, some people would rather not take medication for 4 weeks after travel

Drug Reasons that might make you consider using this drug Reasons that might make you avoid using this drug
Primaquine

Adults: 30 mg base, daily
Children: 0.5 mg/kg base up to adult dose daily

 

Begin 1-2 days prior to travel, daily during travel, and for 7 days after leaving

  • It is one of the most effective medicines for preventing P. vivax and so it is a good choice for travel to places with > 90% P. vivax
  • Good choice for shorter trips because you only have to take the medicine for 7 days after traveling rather than 4 weeks
  • Good for last-minute travelers because the drug is started 1-2 days before traveling to an area where malaria transmission occurs
  • Some people prefer to take a daily medicine
  • Cannot be used in patients with glucose-6-phosphatase dehydrogenase (G6PD) deficiency
  • Cannot be used in patients who have not been tested for G6PD deficiency
  • There are costs and delays associated with getting a G6PD test done; however, it only has to be done once. Once a normal G6PD level is verified and documented, the test does not have to be repeated the next time primaquine is considered
  • Cannot be used by pregnant women
  • Cannot be used by women who are breastfeeding unless the infant has also been tested for G6PD deficiency
  • Some people (including children) would rather not take a medicine every day
  • Some people are concerned about the potential of getting an upset stomach from primaquine

 

Drug Reasons that might make you consider using this drug Reasons that might make you avoid using this drug
Tafenoquine (ArakodaTM)

Adults only: 200 mg per dose.

Begin daily for 3 days prior to travel, weekly during travel, and for 1 week after leaving.

  • One of the most effective drugs for prevention of P. vivax malaria, but also prevents P. falciparum
  • Good choice for shorter trips because you only have to take the medicine once, 1 week after traveling rather than 4 weeks
  • Good for last-minute travelers because the drug is started 3 days before traveling to an area where malaria transmission occurs
  • Cannot be used in patients with glucose-6-phosphatase dehydrogenase (G6PD) deficiency
  • Cannot be used in patients who have not been tested for G6PD deficiency
  • There are costs and delays associated with getting a G6PD test done; however, it only has to be done once. Once a normal G6PD level is verified and documented, the test does not have to be repeated the next time tafenoquine is considered
  • Cannot be used by children
  • Cannot be used by pregnant women
  • Cannot be used by women who are breastfeeding
  • Not recommended in those with psychotic disorders