 | Recommendations for drugs to prevent malaria differ by country of
travel and can be found in the
country-specific tables
of the Yellow Book. Recommended drugs for each country are listed in
alphabetical order and have comparable efficacy in that country. |
| No
antimalarial drug is 100% protective and must be combined with the
use of personal protective measures, (i.e., insect repellent, long sleeves,
long pants, sleeping in a mosquito-free setting or using an
insecticide-treated bednet). |
| For all medicines, also consider the possibility of drug-drug
interactions with other medicines that the person might be taking as well as
other medical contraindications, such as
drug allergies. |
| When several different drugs are recommended for an area, the
following table might help in the decision process. |
| Drug |
Reasons that might make you consider using this drug |
Reasons that might make you avoid using this drug |
| Atovaquone/Proguanil (Malarone) |
| Good for last-minute travelers because the drug is started 1-2
days before traveling to an area where malaria transmission occurs
|
| Some people prefer to take a daily medicine |
| Good choice for shorter trips because you only have to take the
medicine for 7 days after traveling rather than 4 weeks |
| Very well tolerated
medicine – side
effects uncommon |
| Pediatric tablets are available and may be more convenient
|
|
| Cannot be used by women who are pregnant or breastfeeding a
child less than 5 kg |
| Cannot be taken by people with severe renal impairment |
| Tends to be more expensive than some of the other options
(especially for trips of long duration) |
| Some people (including children) would rather not take a
medicine every day
|
|
| Chloroquine |
| Some people would rather take medicine weekly |
| Good choice for long trips because it is taken only weekly |
| Some people are already taking hydroxychloroquine chronically
for rheumatologic conditions. In those instances, they may not have
to take an additional medicine |
| Can be used in all
trimesters of pregnancy |
|
| Cannot be used in areas with chloroquine or mefloquine
resistance |
| May exacerbate psoriasis |
| Some people would rather not take a weekly medication |
| For trips of short duration, some people would rather not take
medication for 4 weeks after travel |
| Not a good choice for last-minute travelers because drug needs
to be started 1-2 weeks prior to travel
|
|
| Doxycycline |
| Some people prefer to take a daily medicine |
| Good for last-minute travelers because the drug is started 1-2
days before traveling to an area where malaria transmission occurs
|
| Tends to be the least expensive antimalarial |
| Some people are already taking doxycycline chronically for
prevention of acne. In those instances, they do not have to take an
additional medicine |
| Doxycycline also can prevent some additional infections (e.g.,
Rickettsiae and
leptospirosis) and so it may be preferred by people planning
to do lots of hiking, camping, and wading and swimming in fresh
water
|
|
| Cannot be used by pregnant women and children <8 years old |
| Some people would rather not take a medicine every day |
| For trips of short duration, some people would rather not take
medication for 4 weeks after travel |
| Women prone to getting vaginal yeast infections when taking
antibiotics may prefer taking a different medicine |
| Persons planning on considerable sun exposure may want to avoid
the increased risk of sun sensitivity |
| Some people are concerned about the potential of getting an
upset stomach
from doxycycline |
|
Mefloquine
(Lariam) |
| Some people would rather take medicine weekly |
| Good choice for long trips because it is taken only weekly |
| Can be used in second and
third trimester of pregnancy and in
first trimester if there is no other option (i.e., postpone
travel) |
|
| Cannot be used in areas with mefloquine resistance |
| Cannot be used in patients with certain psychiatric conditions
|
| Cannot be used in patients with a
seizure disorder
|
| Not recommended for persons with cardiac conduction
abnormalities |
| Not a good choice for last-minute travelers because drug needs
to be started at least 2 weeks prior to travel |
| Some people would rather not take a weekly medication |
| For trips of short duration, some people would rather not take
medication for 4 weeks after travel
|
|
| Primaquine |
| It is the most effective medicine for preventing P. vivax
and so it is a good choice for travel to places with > 90% P.
vivax |
| Good choice for shorter trips because you only have to take the
medicine for 7 days after traveling rather than 4 weeks |
| Good for last-minute travelers because the drug is started 1-2
days before traveling to an area where malaria transmission occurs
|
| Some people prefer to take a daily medicine
|
|
| Cannot be used in patients with glucose-6-phosphatase
dehydrogenase (G6PD) deficiency |
| Cannot be used in patients who have not been tested for G6PD
deficiency |
| There are costs and delays associated with getting a G6PD test
done; however, it only has to be done once. Once a normal G6PD level
is verified and documented, the test does not have to be repeated
the next time primaquine is considered |
| Cannot be used by pregnant women |
| Cannot be used by women who are breastfeeding unless the infant
has also been tested for G6PD deficiency |
| Some people (including children) would rather not take a
medicine every day |
| Some people are concerned about the potential of getting an
upset stomach from primaquine
|
|