From the Guidelines
The recommended prophylaxis for malaria depends on the destination and individual factors, but commonly includes medications such as atovaquone-proguanil (Malarone), doxycycline, mefloquine, or chloroquine, with atovaquone-proguanil being a preferred option due to its efficacy and safety profile, as suggested by the most recent and highest quality study 1.
Key Considerations for Malaria Prophylaxis
- The choice of prophylaxis should be based on the specific malaria risk in the destination, drug resistance patterns, the traveler's health status, and potential side effects.
- Atovaquone-proguanil is taken daily starting 1-2 days before travel, throughout the stay, and for 7 days after return, with adult dosing at 250mg/100mg once daily.
- Doxycycline (100mg daily) is started 1-2 days before travel and continued for 4 weeks after return, but its use is limited by resistance patterns and side effects, as noted in earlier studies 1.
- Mefloquine (250mg weekly) begins 2-3 weeks before travel and continues for 4 weeks after return, but its use is also limited by resistance patterns and side effects.
- Chloroquine (500mg weekly) is only effective in limited regions and starts 1-2 weeks before travel, continuing for 4 weeks after, but its use is largely limited by widespread resistance.
Non-Medication Prevention Measures
- Using insect repellent containing DEET
- Wearing long sleeves and pants
- Sleeping under insecticide-treated bed nets
- Staying in screened or air-conditioned rooms These measures are crucial in preventing malaria, as they reduce the risk of mosquito bites, which are the primary mode of transmission, as emphasized in various guidelines 1.
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. Prophylaxis should begin 1 to 2 days before travel to the malarious area. Prophylaxis should be continued daily during travel in the malarious area and for 4 weeks after the traveler leaves the malarious area The recommended malaria prophylaxis is doxycycline.
- For adults, the dose is 100 mg daily.
- For children over 8 years of age, the dose is 2 mg/kg given once daily up to the adult dose. Prophylaxis should start 1 to 2 days before travel to the malarious area and continue daily during travel and for 4 weeks after leaving the malarious area 2
From the Research
Malaria Prophylaxis
Malaria prophylaxis refers to the measures taken to prevent malaria infection. The recommended prophylaxis for malaria includes:
- Atovaquone/proguanil: a fixed-dose combination tablet of two antimalarial agents, highly effective for the prevention of Plasmodium falciparum malaria 3
- Atovaquone-proguanil: provides effective prophylaxis of P. falciparum malaria, including drug-resistant strains, and is generally well tolerated 4, 5
- Other options: mefloquine, doxycycline, primaquine, and chloroquine plus proguanil, each with their own efficacy and tolerability profiles 4, 6, 7
Efficacy of Atovaquone/Proguanil
The efficacy of atovaquone/proguanil for malaria prophylaxis has been demonstrated in several studies:
- Atovaquone/proguanil was 100% effective in preventing P. falciparum malaria in nonimmune adults, adolescents, and children visiting malaria-endemic regions for ≤28 days 3
- Atovaquone-proguanil was associated with a lower frequency of treatment-related gastrointestinal adverse events and fewer treatment-related adverse events of moderate or severe intensity compared to chloroquine-proguanil 4
- Atovaquone-proguanil was highly efficacious and safe as prophylaxis for P. falciparum malaria, with all evaluable subjects remaining malaria-free during the 10-week prophylaxis period 6
Considerations for Vivax Malaria
For Plasmodium vivax malaria, atovaquone-proguanil is considered causal prophylaxis, but its efficacy against late, hypnozoite reactivation-related attacks is limited: