Malarone Dosing for a 7-Year-Old Child
For a 7-year-old child weighing 20-30 kg, give 1 pediatric tablet (62.5 mg atovaquone/25 mg proguanil) once daily for malaria prophylaxis. 1
Weight-Based Dosing Algorithm
The CDC provides clear weight-based dosing for pediatric malaria prophylaxis with Malarone:
- 11-20 kg: 1 pediatric tablet (62.5 mg/25 mg) once daily 1, 2
- 21-30 kg: 2 adult tablets (250 mg/100 mg) once daily 1, 2
- 31-40 kg: 3 adult tablets once daily 1, 2
- >40 kg: 4 adult tablets once daily (full adult dose) 1, 2
Critical Timing Considerations
Start prophylaxis 1-2 days before entering the malaria-endemic area and continue for only 7 days after leaving, which is substantially shorter than other antimalarials that require 4 weeks post-travel. 3 This shortened post-travel duration is possible because both atovaquone and proguanil are active against hepatic (pre-erythrocytic) stages of P. falciparum, providing causal prophylaxis rather than just suppressive prophylaxis. 3
Administration Guidelines
- Give with food or a milky drink to maximize absorption—dietary fat increases atovaquone absorption 2-3 fold. 4
- Administer at the same time each day for consistent drug levels. 3
Common Pitfalls to Avoid
Do not confuse prophylaxis dosing with treatment dosing. For treatment of acute malaria in the 11-20 kg weight range, the dose is 4 pediatric tablets once daily for 3 days, which is 4 times higher than the prophylaxis dose. 1
If the child vomits within 30 minutes of taking Malarone, repeat the full dose immediately as insufficient absorption has occurred. 5 If vomiting occurs twice or becomes persistent, this may indicate complicated malaria requiring immediate switch to IV artesunate. 5
Safety Profile
Malarone is well-tolerated in children, with headache and abdominal pain being the most common adverse events, occurring at rates similar to placebo. 3 The combination causes significantly fewer gastrointestinal adverse events than chloroquine plus proguanil and fewer neuropsychiatric adverse events than mefloquine. 3
No ophthalmologic monitoring is required with Malarone, unlike chloroquine which can cause retinopathy with long-term use. 6