Travel Health Information Sheets
Updated October 2012
Malaria chemoprophylaxis
There are currently four drug regimens available in the United Kingdom (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 2007.
Updates to the malaria guidelines can be found on the HPA website at: http://www.hpa.org.uk/infections/topics_az/malaria/
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 Table 2 and Table 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 Avloclor® tablets |
||
Mefloquine |
Lariam® tablets |
Weekly dose Effective for most areas of the world Can be used in the last 2 trimesters of pregnancy. (Seek advice regarding use in 1st trimester) |
Needs to be ideally commenced 2 to 3 weeks prior to departure. (Seek advice if travel is imminent) 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 |
*Pregnant women taking proguanil should receive supplementation with 5mg folic acid daily.
Table 2. Adult dosage of malaria chemoprophylaxis
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 (155 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 malaria chemoprophylaxis
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 155mg 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 |
Counterfeit medication
Counterfeit or substandard medications are drugs that have been produced by unauthorised manufacturers, but presented to the consumer as an authorised product. Very often both the packaging and the medication appear virtually identical to the authentic medication.
In parts of Africa, Asia and Latin America, the proportion of counterfeit medication may be as high as 30% [1]. Counterfeit medications may contain inactive substances or toxic ingredients resulting in the individual not responding to treatment, or being harmed by it. Antimalarial medication is particularly prone to counterfeiting and is a contributing factor in malaria treatment failures and drug resistance [2, 3].
Wherever possible travellers should avoid the risk of purchasing counterfeit medication by purchasing all the medication they will need prior to travel. In case travellers require additional supplies they should take copies of their prescriptions of any regular medications with them and consult a legitimate pharmacy. Medications should not be purchased from open markets or street vendors.
The International Association for Medical Assistance to Travellers (IAMAT) and the International Society of Travel Medicine (ISTM) global clinic directory can provide contact details of medical practitioners overseas.
References
1. Green MD. Counterfeit Drugs. In: Centers for Disease Control and Prevention. Health information for international travel 2012. Atlanta, CDC
2. Newton PN, Green MD, Fernández FM et al. Counterfeit and anti-infective drugs. Lancet Inf Dis. 6, 602-13, 2006
3. Worldwide Antimalarial Resistance Network. Antimalarial quality. [Accessed 23 October 2012]. Available at: http://www.wwarn.org/about-us/scientific-groups/antimalarial-quality
Further reading
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