II. Precautions
III. Protocol
- Always check CDC for resistance before prescribing
- CDC Travelers Health for regional recommendations
- Chemoprophylaxis is for prevention only
- Dosing below does not apply to Malaria treatment
- Chemoprophylaxis Schedule
- Agents are started 1-2 weeks before travel
- Agents are continued for 4 weeks after travel
IV. Prevention: First-Line Chemoprophylaxis
- See dosing protocol as above (i.e. starting before and ending after travel)
- Indications (Areas of no Chloroquine Resistance)
- Mexico
- Caribbean
- Haiti and Dominican Republic
- Central America (west of Panama canal)
- Argentina
- Some areas in Middle East
- Some areas of China
-
Chloroquine (Aralen)
- Safe in pregnancy (all trimesters)
- Adult: 500 mg (300 mg base) orally once weekly
- Child: 8.3 mg/kg (5 mg/kg of base, up to adult dose) once weekly
-
Hydroxychloroquine (Plaquenil)
- Adult: 400 mg (310 mg base) orally once weekly
- Child: 6.5 mg/kg (5 mg/kg of base, up to adult dose) once weekly
V. Prevention: Second-line chemoprophylaxis (if No Mefloquine resistance)
- Indications
- Chloroquine resistance
- Contraindications (relative)
-
Mefloquine (Lariam)
- See Mefloquine for neuropsychiatric and vestibular adverse effects (FDA black box warnings)
- Safe in second and third trimesters of pregnancy (avoid in first trimester)
- Adult: 250 mg (228 mg base) orally weekly
- Child: Safe over 3 months of age
- See Mefloquine for pediatric dosing
VI. Prevention: Third-Line Chemoprophylaxis
- Indications
- Short term travel to Chloroquine resistance areas
- Mefloquine resistance areas
- Thailand - Cambodia border
- Thailand - Myanmar (Burma) border
- Protocol for Doxycycline and Malarone
- Differs from protocol with Chloroquine and Mefloquine (which are instead taken weekly)
- Start 1-2 days before travel
- Continue for 4 weeks after return from travel
-
Doxycycline (Vibramycin)
- Contraindicated in lactating women and children under age 8 years
- Adult Dosing: 100 mg orally daily
- Pediatric Dosing (may use if older than age 8)
- Dose: 2 mg/kg/day up to 100 mg orally daily
-
Atovaquone/Proguanil (Malarone)
- Contraindicated if GFR <30 ml/min
- Adults: 1 tablet (250 mg/100 mg) orally daily
- Start 1-2 days before travel
- Stop 7 days after return
- Children
- See Malarone
VII. Prevention:
- Indications
- Short-term travel to areas with >90% Plasmodium VivaxMalaria (some regions of central and south america)
- Protocol
- Start 1-2 days before travel and continue for 1 week after travel
- Adults
- Primaquine 52.6 mg (30 mg base) orally daily
- Children
- Primaquine 0.8 mg/kg salt (0.5 mg/kg base) up to adult dose orally daily
VIII. Prevention: Terminal Chemoprophylaxis
- Indications (on leaving endemic area)
- Prolonged exposure to P. vivax or P. ovale
- Taken for 14 days on leaving endemic area
- Contraindications
- Pregnancy (Pregnancy Category C)
- G6PD Deficiency
- Adult dose
- Primaquine 52.6 mg (30 mg base) orally daily for 14 days
IX. Prevention: Chemoprophylaxis with other agents (adult dosing)
-
Primaquine
- Dosing: 52.6 mg daily
- Start 1-2 days before travel
- Continue for 7 days after return
- Azithromycin (Zithromax) 250 mg PO qd
- Tafenoquine (Etaquine) 250 mg PO weekly
- Pyrimethamine with sulfadoxine (Fansidar)
X. Management: Emergency treatment prescription
- Indications
- Patients refusing Malaria Prophylaxis
- Travel to remote areas without medical facilities
- Protocol
- Start one of the followin agents at the first onset of fever, chills, or muscle aches
- Prescribe 3 day course of one of the following agents
- Preparations
- Atovaquone/Proguanil (Malarone) high dose or
- Artemether/Lumefantrine (Coartam)
XII. References
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Related Studies (from Trip Database) Open in New Window
| Concepts | Therapeutic or Preventive Procedure (T061) |
| SnomedCT | 420848008, 81364009, 268592001 |
| Italian | Profilassi della malaria, Profilassi malarica |
| English | Anti-malarial prophylaxis, Antimalarial drug prophylaxis, Malarial prophylaxis, Antimalarial prophylaxis (procedure), Antimalarial prophylaxis, Malaria prophylaxis, malaria prophylaxis, Prescription of prophylactic anti-malarial, Prescription of prophylactic anti-malarial (procedure) |
| Spanish | profilaxis antipalúdica, profilaxis contra la malaria, profilaxis antipalúdica (procedimiento), profilaxis farmacológica antipalúdica, prescripción de un agente profiláctico antipalúdico (procedimiento), prescripción de un agente profiláctico antipalúdico, Profilaxis de paludismo |
| Dutch | malaria profylaxe, malariaprofylaxe |
| French | Prophylaxie du paludisme, Prophylaxie antipaludéenne |
| Japanese | マラリア予防, ﾏﾗﾘｱﾖﾎﾞｳ |
| Czech | Profylaxe malárie, Antimalarická profylaxe |
| Hungarian | Malária profilaxis |
| Portuguese | Profilaxia da malária |
| German | Malariaprophylaxe |
