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Drugs use in the prophylaxis of malaria

 

DRUG

USAGE

ADULT DOSE

PEDIATRIC DOSE

COMMENTS

Atovaquone-proguanil

Prophylaxis in all areas Adult tablets contain 250 mg atovaquone and 100 mg proguanil hydrochloride. 1 adult tablet orally, daily Pediatric tablets contain 62.5 mg atovaquone and 25 mg proguanil hydrochloride.

5–8 kg: 1/2 pediatric tablet daily

>8–10 kg: 3/4 pediatric tablet daily

>10–20 kg: 1 pediatric tablet daily

>20–30 kg: 2 pediatric tablets daily

>30–40 kg: 3 pediatric tablets daily

>40 kg: 1 adult tablet daily
Begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious area and for 7 days after leaving such areas. Contraindicated in people with severe renal impairment (creatinine clearance <30 mL/min). Atovaquone-proguanil should be taken with food or a milky drink. Not recommended for prophylaxis for children weighing <5 kg, pregnant women, and women breastfeeding infants weighing <5 kg. Partial tablet doses may need to be prepared by a pharmacist and dispensed in individual capsules, as described in the text.

Chloroquine phosphate

Prophylaxis only in areas with chloroquine-sensitive malaria 300 mg base (500 mg salt) orally, once/week 5 mg/kg base (8.3 mg/kg salt) orally, once/week, up to maximum adult dose of 300 mg base Begin 1–2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious area and for 4 weeks after leaving such areas. May exacerbate psoriasis.

Doxycycline

Prophylaxis in all areas 100 mg orally, daily ≥8 years of age: 2.2 mg/kg up to adult dose of 100 mg/day Begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious area and for 4 weeks after leaving such areas. Contraindicated in children <8 years of age and pregnant women.

Hydroxychloro-
quine sulfate

An alternative to chloroquine for prophylaxis only in areas with chloroquine-sensitive malaria 310 mg base (400 mg salt) orally, once/week 5 mg/kg base (6.5 mg/kg salt) orally, once/week, up to maximum adult dose of 310 mg base Begin 1–2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious area and for 4 weeks after leaving such areas.

Mefloquine

Prophylaxis in areas with mefloquine-sensitive malaria 228 mg base (250 mg salt) orally, once/week ≤9 kg: 4.6 mg/kg base (5 mg/kg salt) orally, once/week

>9-19 kg: 1/4 tablet once/week

>19-30 kg: 1/2 tablet once/week

>30-45 kg: 3/4 tablet once/week

>45 kg: 1 tablet once/week
Begin ≥2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious area and for 4 weeks after leaving such areas. Contraindicated in people allergic to mefloquine or related compounds (quinine, quinidine) and in people with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures. Use with caution in persons with psychiatric disturbances or a previous history of depression. Not recommended for persons with cardiac conduction abnormalities.

Primaquine 1

Prophylaxis for short-
duration travel to areas with principallyP.vivax
30 mg base (52.6 mg salt) orally, daily 0.5 mg/kg base (0.8 mg/kg salt) up to adult dose orally, daily Begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious area and for 7 days after leaving such areas. Contraindicated in people with G6PD deficiency. Also contraindicated during pregnancy and lactation, unless the infant being breastfed has a documented normal G6PD level.
Used for presumptive antirelapse therapy (terminal prophylaxis) to decrease the risk for relapses ofP. vivax andP. ovale 30 mg base (52.6 mg salt) orally, daily for 14 days after departure from the malarious area 0.5 mg/kg base (0.8 mg/kg salt) up to adult dose orally, daily for 14 days after departure from the malarious area Indicated for people who have had prolonged exposure to P. vivax, P. ovale, or both. Contraindicated in people with G6PD deficiency. Also contraindicated during pregnancy and lactation, unless the infant being breastfed has a documented normal G6PD level.

Abbreviation: G6PD, glucose-6-phosphate dehydrogenase.
1All people who take primaquine should have a documented normal G6PD level before starting the medication.

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