From the Guidelines
Mefloquine (Lariam) is a recommended option for malaria prophylaxis, particularly for travel to areas with chloroquine-resistant P. falciparum, with a dose of 250mg taken once weekly. Several effective medications are available for malaria prophylaxis, including Mefloquine (Lariam), Atovaquone-proguanil (Malarone), Doxycycline, and Chloroquine (in limited areas) 1. The choice of prophylaxis depends on the destination's resistance patterns, medical history, and potential side effects. Mefloquine can cause neuropsychiatric effects and should be avoided in those with psychiatric conditions or seizure disorders.
Key Considerations
- Mefloquine is taken as a 250mg tablet once weekly, starting 2-3 weeks before travel to malaria-endemic areas, continuing during travel, and for 4 weeks after leaving.
- Atovaquone-proguanil is taken daily (adult dose: 250mg/100mg) starting 1-2 days before travel, during travel, and for 7 days after.
- Doxycycline (100mg daily) follows a similar schedule to mefloquine but may cause photosensitivity and gastrointestinal side effects.
- Chloroquine (500mg weekly) is now only effective in limited regions due to widespread resistance.
Additional Measures
Regardless of medication choice, it is also recommended to use insect repellent, bed nets, and protective clothing to prevent mosquito bites 1. Travelers should review their itinerary in detail and compare it with information on areas of risk within a given country to determine the actual risk of acquiring malaria 1.
Side Effects and Interactions
Chloroquine and hydroxychloroquine rarely cause serious adverse reactions when taken at prophylactic doses for malaria, but minor side effects may occur, such as gastrointestinal disturbance, headache, dizziness, blurred vision, and pruritus 1.
From the FDA Drug Label
Prevention of Malaria Mefloquine is indicated for the prophylaxis of P. falciparum and P. vivax malaria infections, including prophylaxis of chloroquine-resistant strains of P. falciparum.
Mefloquine (Lariam) is an option for malaria prophylaxis, including for areas with chloroquine-resistant strains of P. falciparum.
- The first dose of mefloquine should be taken one week prior to arrival in an endemic area.
- It is essential to note that no chemoprophylactic regimen is 100% effective, and protective clothing, insect repellents, and bed nets are important components of malaria prophylaxis. 2
From the Research
Malaria Prophylaxis Options
- Atovaquone-proguanil is a highly effective option for the prevention of Plasmodium falciparum malaria, with an efficacy rate of 100% in nonimmune adults, adolescents, and children 3
- Mefloquine (Lariam) is also an option for malaria prophylaxis, but it has been associated with more neuropsychiatric adverse events compared to atovaquone-proguanil 3, 4
- Chloroquine plus proguanil is another option, but its effectiveness is lower, especially in areas with multidrug-resistant malaria 3, 4
- Primaquine is considered the chemoprophylactic agent of choice for areas with high co-circulation of P. falciparum and P. vivax, as it is effective against late, hypnozoite reactivation-related attacks 5
- Doxycycline is also an option for malaria prophylaxis, but its effectiveness against P. vivax is lower compared to primaquine 5
Considerations for Malaria Prophylaxis
- The choice of prophylaxis should be based on patient characteristics and preferences, as well as the specific travel destination and duration of stay 6, 7
- All travelers to malaria-endemic regions should be prescribed prophylaxis, and the accurate, timely, and species-specific diagnosis of malaria is essential for successful treatment 6, 7
- The World Health Organization recommends treating uncomplicated cases of malaria with artemisinin combination therapy, except in the first trimester of pregnancy 7
- Intravenous artesunate is the treatment of choice for severe malaria, which is mainly caused by Plasmodium falciparum 6, 7
Adverse Events and Tolerability
- Atovaquone-proguanil is generally well tolerated, with fewer gastrointestinal adverse events compared to chloroquine plus proguanil, and fewer neuropsychiatric adverse events compared to mefloquine 3, 4
- Mefloquine has been associated with more neuropsychiatric adverse events, including anxiety, depression, and psychosis 3, 4
- Chloroquine plus proguanil has been associated with more gastrointestinal adverse events, including nausea, vomiting, and diarrhea 3, 4