From the Guidelines
The recommended dosage for prophylactic antimalarial medication is 300 mg chloroquine (base) weekly, as stated in the most recent and highest quality study available 1.
Key Considerations
- The choice of medication depends on the destination's malaria risk profile and resistance patterns, as well as individual factors like pregnancy status, age, and medical conditions.
- Taking these medications consistently at the same time each day or week is crucial for maintaining protective blood levels.
- Side effects vary by medication, with some having fewer side effects than others.
Medication Options
- Chloroquine phosphate: 300 mg weekly starting 1-2 weeks before travel, during the stay, and for 4 weeks after departure 1.
- Other medications like mefloquine, doxycycline, and atovaquone-proguanil may also be considered, but the dosage and recommendations may vary based on the destination and individual factors.
Important Notes
- Compliance is essential, and most deaths are in those who do not comply fully with the recommended prophylaxis regimen 1.
- Continue to take chemoprophylaxis for four weeks after returning to a non-malarial area to ensure maximum protection.
From the FDA Drug Label
For the prophylaxis of malaria: For adults, the recommended dose is 100 mg daily. For children over 8 years of age, the recommended dose is 2 mg/kg given once daily up to the adult dose. The recommended dosage for prophylactic antimalaria medication is:
- 100 mg daily for adults
- 2 mg/kg daily for children over 8 years of age, up to the adult dose 2
From the Research
Prophylactic Antimalaria Medication Dosage
The recommended dosage for prophylactic antimalaria medication varies depending on the specific medication and individual factors.
- Atovaquone-Proguanil: The study 3 suggests that atovaquone-proguanil provides causal prophylaxis for Plasmodium falciparum, but its efficacy for Plasmodium vivax is not known.
- Mefloquine: The study 4 found that mefloquine is effective in preventing malaria, but it has a higher risk of adverse effects such as abnormal dreams, insomnia, anxiety, and depressed mood compared to atovaquone-proguanil and doxycycline.
- Doxycycline: The study 5 found that doxycycline is one of the best-tolerated regimens, with fewer reports of adverse effects compared to mefloquine.
- Primaquine: The study 3 suggests that primaquine should be considered as the chemoprophylactic agent of choice for areas with high co-circulation of P. falciparum and P. vivax.
Cost Considerations
The cost of malaria chemoprophylaxis is an important factor to consider.
- The study 6 found that generic doxycycline hyclate is the least expensive regimen, followed by primaquine alone.
- Atovaquone-proguanil is less expensive than mefloquine for short durations of exposure, but more expensive for longer durations.
- The cost of primaquine includes the cost of detecting glucose 6-phosphate dehydrogenase (G6PD) deficiency before administration.
Key Findings
- The choice of antimalarial agent depends on individual factors, including the risk of adverse effects, pill burden, and cost.
- Atovaquone-proguanil, doxycycline, and mefloquine are effective in preventing malaria, but have different adverse effect profiles.
- Primaquine is a cost-effective option for short durations of exposure, but requires screening for G6PD deficiency before administration.