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)

Chloroquine

Aralen

• 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

• Not a good choice for last-minute travelers because drug needs to be started 1-2 weeks prior to travel

Doxycycline

• 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

• 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

• 100 g PO Daily with food

• Cannot be used by pregnant women and children <8 years old

• 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 during pregnancy

• 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

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

• Cannot be used by pregnant women

• Cannot be used by women who are breastfeeding unless the infant has also been tested for G6PD deficiency

PLAQUENIL®

HYDROXYCHLOROQUINE

• The drug possesses antimalarial actions and also exerts a beneficial effect in lupus erythematosus (chronic discoid or systemic) and acute or chronic rheumatoid arthritis. The precise mechanism of action is not known.

• PLAQUENIL is indicated for the suppressive treatment and treatment of acute attacks of malaria due to Plasmodium vivax P. malariae, P. ovale, and susceptible strains of P.falciparum. It is also indicated for the treatment of discoid and systemic lupus erythematosus, and rheumatoid arthritis.

• Use of this drug is contraindicated (1) in the presence of retinal or visual field changes attributable to any 4-aminoquinoline compound, (2) in patients with known hypersensitivity to 4-aminoquinoline compounds, and (3) for long-term therapy in children.

• PLAQUENIL is not effective against chloroquine-resistant strains of P. falciparum.

• Children are especially sensitive to the aminoquinoline compounds. A number of fatalities have been reported following the accidental ingestion of chloroquine, sometimes in relatively small doses (0.75 g or 1 g in one 3-year-old child). Patients should be strongly warned to keep these drugs out of the reach of children.

• Use of PLAQUENIL in patients with psoriasis may precipitate a severe attack of psoriasis. When used in patients with porphyria the condition may be exacerbated. The preparation should not be used in these conditions unless in the judgment of the physician the benefit to the patient outweighs the possible hazard. Usage in Pregnancy—Usage of this drug during pregnancy should be avoided except in the suppression or treatment of malaria when in the judgment of the physician the benefit outweighs the possible hazard. It should be noted that radioactively-tagged chloroquine administered intravenously to pregnant, pigmented CBA mice passed rapidly across the placenta. It accumulated selectively in the melanin structures of the fetal eyes and was retained in the ocular tissues for five months after the drug had been eliminated from the rest of the body.