What is the dosing for prophylaxis of malaria with antimalarial medication (Anti-Malarial)?

From the Guidelines

For malaria prevention, the most effective medication regimen is Atovaquone-proguanil (Malarone) taken once daily, starting 1-2 days before entering a malaria-endemic area, continuing throughout the stay, and for 7 days after leaving, as recommended by the most recent and highest quality study 1.

Malaria Prevention Medications

The following medications are available for malaria prevention:

• Atovaquone-proguanil (Malarone): taken once daily, starting 1-2 days before entering a malaria-endemic area, continuing throughout the stay, and for 7 days after leaving. The adult dose is one tablet (250mg atovaquone/100mg proguanil) daily, while children's dosing is weight-based.
• Doxycycline: taken at 100mg once daily for adults, starting 1-2 days before travel, continuing during the trip, and for 4 weeks after leaving.
• Mefloquine (Lariam): taken weekly, with adults using 250mg, starting 2-3 weeks before travel, during the trip, and for 4 weeks after departure.
• Chloroquine: can be used in areas without resistance at 500mg weekly for adults, following the same schedule as mefloquine.

Considerations for Medication Choice

The choice of medication depends on the destination's resistance patterns, duration of travel, and individual factors like pregnancy, age, and medical conditions. Side effects vary by medication, with doxycycline causing sun sensitivity, mefloquine potentially causing neuropsychiatric effects, and atovaquone-proguanil generally being well-tolerated but more expensive.

Additional Protective Measures

Regardless of medication choice, additional protective measures like insect repellent, bed nets, and appropriate clothing are essential components of malaria prevention, as recommended by 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 dosing for prevention of malaria medication is as follows:

• Adults: 100 mg daily
• Children over 8 years of age: 2 mg/kg given once daily up to the adult dose Prophylaxis should start 1 to 2 days before travel and continue for 4 weeks after leaving the malarious area 2

From the Research

Dosing for Prevention of Malaria Medication

• The dosing for prevention of malaria medication depends on various factors, including the type of malaria, the region of travel, and the individual's medical history 3.
• Atovaquone-proguanil is considered a causal prophylaxis for Plasmodium falciparum, but its efficacy for Plasmodium vivax is not well established 4.
• A study comparing atovaquone-proguanil with chloroquine-proguanil found that atovaquone-proguanil had a lower frequency of treatment-related gastrointestinal adverse events and adverse events of moderate or severe intensity 5.
• Mefloquine is one of four antimalarial agents commonly recommended for preventing malaria in travelers to malaria-endemic areas, but it has been associated with psychological side effects such as abnormal dreams, insomnia, anxiety, and depressed mood 6.
• A comparison of mefloquine with atovaquone-proguanil found that mefloquine users were more likely to discontinue their medication due to adverse effects, and were also more likely to report abnormal dreams, insomnia, anxiety, and depressed mood 6.
• The choice of antimalarial agent depends on individual travelers' assessment of the importance of specific adverse effects, pill burden, and cost 6.
• Doxycycline and atovaquone-proguanil are considered to be the best-tolerated regimens, while mefloquine is associated with adverse neuropsychiatric outcomes 7.

Chemoprophylaxis Options

• Several options exist for chemoprophylaxis, including atovaquone-proguanil, doxycycline, mefloquine, and primaquine 3, 7.
• The selection of chemoprophylaxis should be based on patient characteristics and preferences, as well as the region of travel and the type of malaria 3.
• Primaquine should be considered as the chemoprophylactic agent of choice for areas with high co-circulation of P. falciparum and P. vivax 4.

Adverse Effects

• Atovaquone-proguanil has been associated with fewer adverse effects compared to chloroquine-proguanil and mefloquine 5, 6.
• Mefloquine has been associated with psychological side effects such as abnormal dreams, insomnia, anxiety, and depressed mood 6.
• Doxycycline has been associated with fewer adverse effects compared to mefloquine, including fewer reports of nausea, dizziness, and photosensitivity 6.