From the Guidelines
Malaria prophylaxis involves taking medications to prevent malaria infection when traveling to endemic regions, with atovaquone-proguanil (Malarone) being the recommended option for most travelers, taken daily starting 1-2 days before travel, throughout the stay, and for 7 days after leaving the malaria-endemic area. The adult dose is one tablet (250mg atovaquone/100mg proguanil) daily 1. Alternative options include doxycycline (100mg daily, starting 1-2 days before travel and continuing for 4 weeks after return), or mefloquine (250mg weekly, starting 2-3 weeks before travel and continuing for 4 weeks after return) 1. Chloroquine (500mg weekly) can be used in the few areas where chloroquine-sensitive malaria still exists 1. Medication choice depends on the destination's resistance patterns, duration of travel, and individual factors like pregnancy, age, and medical conditions. Beyond medication, preventive measures include:
- Using insect repellent containing DEET
- Wearing long sleeves and pants especially during evening hours
- Sleeping under insecticide-treated bed nets
- Using air conditioning when available 1. These medications work by targeting different stages of the Plasmodium parasite's life cycle, preventing it from establishing infection in the liver or multiplying in the bloodstream. Even with prophylaxis, travelers should seek immediate medical attention if they develop fever or flu-like symptoms during or after travel to malaria-endemic areas. It is essential to note that compliance with the recommended prophylaxis regimen is crucial, as most deaths from malaria occur in individuals who do not comply fully with their prophylaxis regimen 1. Travelers should also be aware that no prophylaxis is infallible, and all fever and flu-like illnesses occurring within a year of returning from malarious regions need to be urgently investigated with malaria in mind 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 When mefloquine is taken concurrently with oral live typhoid vaccines, attenuation of immunization cannot be excluded. When used as prophylaxis, the first dose of mefloquine hydrochloride tablets should be taken one week prior to arrival in an endemic area; Chloroquine taken in the dose recommended for malaria prophylaxis can reduce the antibody response to primary immunization with intradermal human diploid-cell rabies vaccine.
Malaria Prophylaxis Recommendations:
- Doxycycline: 100 mg daily for adults, 2 mg/kg daily for children over 8 years old, starting 1-2 days before travel and continuing for 4 weeks after leaving the malarious area 2.
- Mefloquine: first dose taken one week prior to arrival in an endemic area, with daily doses continued during travel and for an unspecified duration after leaving the area, but with consideration of the need for alternative medications if side effects occur 3.
- Chloroquine: may reduce antibody response to certain vaccines, such as the rabies vaccine, when taken for malaria prophylaxis 4.
Key Considerations:
- The choice of prophylaxis depends on various factors including the destination, duration of stay, and individual patient factors.
- No chemoprophylactic regimen is 100% effective, and protective clothing, insect repellents, and bed nets are important components of malaria prophylaxis 3.
From the Research
Malaria Prophylaxis Options
- Chloroquine phosphate is still the drug of choice in locations where malaria remains chloroquine-sensitive 5
- In chloroquine-resistant areas, mefloquine hydrochloride, doxycycline, or proguanil may be used 5
- Atovaquone-proguanil is a safe and effective option for prevention of falciparum malaria in non-immune travelers 6, 7
Comparison of Prophylaxis Regimens
- Atovaquone-proguanil had fewer reports of adverse effects compared to mefloquine and chloroquine-proguanil 6, 7
- Doxycycline had fewer reported neuropsychiatric events than mefloquine 7
- Atovaquone-proguanil and doxycycline are the best tolerated regimens, while mefloquine is associated with adverse neuropsychiatric outcomes 7
Recommendations for Travelers
- All travelers to malarious areas should receive appropriate chemoprophylaxis before they leave on their trip 5, 8
- Travelers should be taught general protective measures against malaria, such as anti-mosquito measures 5
- Physicians should consider the diagnosis of malaria when fever develops in travelers returning from malarious areas 8