Malaria Chemoprophylaxis

Travelers to areas where malaria occurs should discuss their travel plans with a physician well before departure. Drugs to prevent malaria are usually prescribed for travelers to malarious areas. Travelers from different countries may receive different recommendations, reflecting differences in approach and availability of medicines in different countries. Travelers visiting only cities or rural areas where there is no risk of malaria may not require preventive drugs; an exact itinerary is necessary to decide the degree of protection required.

Strict adherence to the recommended doses and schedules of the antimalarial drug selected is necessary for effective protection.

Take tablets on the same day each week or, in the case of tablets to be taken daily, at the same time each day.

Take tablets after meals.

Take the recommended doses 1 to 2 weeks before travel, throughout the trip, and for 4 weeks after leaving the malarious area.

Don't stop taking the tablets after arriving home; it is essential to complete the full dosage.


MEDICATION STRATEGIES

Choosing antimalarial drugs has become complicated by the appearance of drug-resistant strains of malaria. In Mexico, Central America, Haiti, the Dominican Republic, the Middle East, the preventive drug of choice is weekly Chloroquine. In all other malarious areas the drug of choice is weekly Mefloquine (Lariam). If Mefloquine cannot be taken, an effective alternative is daily Doxycycline or Malarone. If neither Mefloquine, Malarone nor Doxycycline can be taken, Chloroquine (with or without Proguanil a drug not available in the United States) is a third alternative; unfortunately, this drug combination is much less effective in most areas. If Chloroquine is used in drug-resistant areas, a suitable stand-by treatment should be carried in case malarial symptoms occur and medical help cannot be obtained within 24 hours.

All medicines have some side effects; however, if a serious side effect occurs, the traveler should seek medical help and discontinue taking the antimalarial drug. Mild nausea, occasional vomiting, or loose stools are not adequate reasons for stopping the antimalarial drug. The seriousness of malaria warrants tolerating temporary side effects.


MALARONE

MALARONE is a combination of atovaquone (250mg) and proguanil (100mg) used for the prevention and treatment of malaria. The adult dose for prophylaxis is 250 mg atovaquone/ 100 mg proguanil (1 adult tablet) orally once daily. For children who weigh more than 11 kg, doses vary by body weight. This drug should be taken 1-2 days before travel, daily while there, and continued daily for 1 week after departure from the malarious area. Side effects of MALARONE tend to be uncommon and include abdominal pain, nausea vomiting and headache. Due to lack of data this drug is not currently recommended in pregnant women, in women breastfeeding infants or in infants who weigh less than 11 kg.


MEFLOQUINE

This drug is marketed in the United States under the name Lariam. The adult dose is 250 mg (one tablet) once a week. Children are dosed based on weight. MEFLOQUINE should be taken one to two weeks prior to departure, weekly during travel and taken for four weeks after leaving malaria endemic area.

Minor side effects one may experience while taking MEFLOQUINE include gastrointestinal disturbances and dizziness, which tend to be mild and temporary. More serious side effects at the recommended dosage have rarely occurred. MEFLOQUINE is contraindicated in patients with a known hypersensitivity to MEFLOQUIINE or related compounds (e.g., quinine and quinidine). MEFLOQUINE should not be prescribed for prophylaxis in patients with active depression, a recent history of depression, generalized anxiety disorder, psychosis, or schizophrenia or other major psychiatric disorders, cardiac conduction abnormalities or with a history of convulsions. In consultation with a physician, pregnant women and children less than 30 pounds may use MEFLOQUINE, when travel to an area with Chloroquine-resistant malaria is unavoidable.


DOXYCYCLINE

Travelers who cannot take MEFLOQUINE, CHLOROQUINE or MALARONE should take DOXYCYCLINE to prevent malaria if they are traveling in a malarious area. This drug is taken every day at an adult dose of 100 mg, to begin on the day before entering the malarious area, while there, and continued for 4 weeks after leaving. If DOXYCYCLINE is used, there is no need to take other preventive drugs, such as CHLOROQUINE.

Possible side effects include skin photosensitivity that may result in an exaggerated sunburn reaction. Wearing a hat and using sunblock can minimize this risk. Women who take DOXYCYCLINE may develop vaginal yeast infections and should discuss this with their doctor before using DOXYCYCLINE. Pregnant women during their entire pregnancy should not use DOXYCYCLINE. Children under 8 years of age or travelers with a known hypersensitivity to DOXYCYCLINE should not take this medication.


CHLOROQUINE

CHLOROQUINE is used to prevent malaria for travelers who cannot take MEFLOQUINE , MALARONE or DOXYCYCLINE. CHLOROQUINE is often marketed in the United States under the brand name Aralen. The adult dosage is 500 mg (salt) once a week. This drug should be taken one week before entering a malarious area, weekly while there, and weekly for 4 weeks after leaving the malarious area. Travelers to sub-Saharan Africa who use CHLOROQUINE should, if possible, also consider taking simultaneously, PROGUANIL. The adult dose of PROGUANIL is 200 mg/day. PROGUANIL is not available in the United States, but can be purchased in Canada, Europe, and many African countries.

Rare side effects to CHLOROQUINE include upset stomach, headache, dizziness, blurred vision, and itching. Generally these effects do not require the drug to be discontinued.


FANSIDAR

CHLOROQUINE may not prevent malaria (in areas where there is CHLOROQUINE resistant malaria) and travelers who use CHLOROQUINE must take additional measures. In addition to stringent personal protection measures, they should also take with them one or more treatment doses of FANSIDAR. Each treatment dose for an adult consists of 3 tablets. These 3 tablets should be taken as a single dose to treat any fever during the travel if professional medical care is not available within 24 hours. Such presumptive self-treatment of a possible malaria infection is only a temporary measure; the traveler should seek medical care as soon as possible. Travelers should continue taking the weekly dose of CHLOROQUINE after treatment with FANSIDAR.


PRIMAQUINE

In certain cases, where there has been extended exposure to vivax malaria and only CHLOROQUINE has been used and/ or malaria prophylaxis was prematurely discontinued, PRIMAQUINE may be used to eliminate the possibility of a delayed malaria attack. The usual adult dose is 15 mg-30mg base daily for 14 days. PRIMAQUINE is contraindicated during pregnancy.