Health Professionals

Travel Health Information Sheets

Malaria Chemoprophylaxis                                                                

There are currently four drug regimens available in the UK for the prevention of malaria. Detailed information on each one, together with country recommendations, and interim updates, can be found in the Guidelines for malaria prevention in travellers from the United Kingdom for 2003.

Updates to the malaria guidelines can be found on the HPA website at: http://www.hpa.org.uk/infections/topics_az/malaria/

guidelines.htm

The choice of drug should be determined following a malaria risk assessment.  It should be determined in consultation with the traveller and take into account potential medical contraindications to individual agents.

In addition to appropriate malaria chemoprophylaxis, travellers should be advised on methods of insect bite avoidance and the importance of prompt medical assistance should symptoms suggestive of malaria develop.

Table 1 provides a summary of the advantages and disadvantages of each regimen.

The adult and paediatric dosages can be found in Tables 2 and 3.

Advice on malaria chemoprophylaxis for women who are pregnant or breastfeeding can be found in the FAQ section.

Table 1. Advantages and Disadvantages of Malaria Chemoprophylactics

Chemoprophylaxis drug

Presentation

Advantages

Disadvantages

Proguanil

 

Paludrine® tablets

Low cost

Well tolerated

Suitable for pregnant or breastfeeding women

Increasing resistance of P. falciparum to chloroquine

Large number of tablets required if taken in combination

Chloroquine

Nivaquine® syrup or tablets

Avloclor® tablets

Mefloquine

Lariam® tablets

Weekly dose

Effective for most areas of the world

Can be used in the last 2 trimesters of pregnancy

Needs to be commenced 2 to 3 weeks prior to departure

May cause neuro-psychiatric adverse events

Doxycycline

Capsule

Low cost

Generally well tolerated

Can be commenced close to departure date

May cause photosensitivity

May cause vaginal yeast infections in women

Unsuitable for children under 12 years

Atovaquone/proguanil

Malarone® tablets

Well tolerated

Can be commenced close to departure date

Short course

Expensive


Table 2. Adult Dosage of Anti-Malarials

Regimen

Tablet Size

Adult Dose

Proguanil

100 mg

2 tablets daily, begin 1 wk before travel and continue for 4 wk after travel

Chloroquine phosphate

250 mg salt

(150 mg base)

2 tablets weekly, begin 1 wk before travel and continue for 4 wk after travel

Mefloquine

250 mg salt

(228 mg base)

One tablet weekly, begin 2-3 wk before travel and continue for 4 wk after travel*

Doxycycline

100 mg

One tablet daily, begin 1 to 2 d before travel and continue for 4 wk after travel

Atovaquone/

proguanil

250 mg atovaquone/ 100 mg proguanil

One tablet daily, begin 1 to 2 d before travel and continue for 7 d after travel

* Mefloquine is ideally begun 2 - 3 weeks before departure to reach effective blood levels, and evaluate for adverse effects.  This is particularly important for first time users

 

Table 3. Paediatric Dosage of Anti-Malarials

The dosage of malaria chemoprophylaxis for children should always be adjusted according to the weight of the child.

Dosages for children can be found in the table below.

Weight (kg)

Chloroquine

150mg base

Proguanil

100mg

Mefloquine

250mg

Doxycycline

100mg

Under 6kg

¼ tablet

¼ tablet

Not recommended

Not recommended

6.0 - 9.9

½ tablet

½ tablet

¼ tablet

Not recommended

10.0 - 15.9

¾ tablet

¾ tablet

¼ tablet

Not recommended

16.0 - 24.9

1 tablet

1 tablet

½ tablet

Not recommended

25.0 - 44.9

1½ tablets

1½ tablets

¾ tablet

Adult dose from 12 years of age

1 tablet

45 and over

2 tablets

(adult dose)

2 tablets

(adults dose)

1 tablet

(adult dose)

1 tablet

(adult dose)

 

Paediatric dosage of atovaquone/proguanil (Malarone®)

Weight (Kg)

Number of paediatric tablets

Under 11

Not recommended

11.0 - 20.9

1 paediatric tablet

21.0 - 30.9

2 paediatric tablets

31.0 - 40.0

3 paediatric tablets

Over 40.0

4 paediatric tablets, or 1 adult tablet