When should travelers begin malaria prophylaxis?
While a study of the long-term use of mefloquine in 421 healthy Peace Corps volunteers has shown it to be safe,6 clinical trials and case reports indicate that a loading dose of mefloquine is associated with adverse drug events, which include neuropsychiatric and gastrointestinal symptoms.4,7
TABLE
Evidence-based recommendations for prevention of malaria2-3,8
| DRUG | USAGE | ADULT DOSE | TREATMENT SCHEDULE |
|---|---|---|---|
| Atovaquone/proguanil Contraindicated in pregnancy | Prophylaxis in areas with chloroquine-resistant or mefloquine-resistant P falciparum | 1 tablet orally each day 250 mg atovaquone and 100 mg proguanil hydrochloride) | Daily from 1 day prior to entry until 7 days after leaving |
| Chloroquine | Prophylaxis only in areas with chloroquine-sensitive P falciparum | 300 mg base (500 mg salt) orally, once/week | Weekly from 2 weeks prior to entry until 4 weeks after leaving (take on the same day of the week) |
| Doxycycline Contraindicated in children <8 years of age and pregnant women | Prophylaxis in areas with chloroquine-resistant or mefloquine-resistant P falciparum | 100 mg orally, daily | Daily from 1 day prior to entry until 4 weeks after leaving |
| Mefloquine | Prophylaxis in areas with chloroquine-resistant P falciparum | 228 mg base (250 mg salt) orally, once/week | Weekly from 2–7 weeks before entry until 4 weeks after leaving (take on the same day of the week) |
| Primaquine | An option for prophylaxis in special circumstances | 30 mg base (52.6 mg salt) orally, daily | Daily from 1 day prior to entry until 7 days after leaving |
Recommendations from others
The World Health Organization (WHO) states that “weekly mefloquine should be started at least 1 week, but preferably 2–3 weeks before departure, to achieve higher pre-travel blood levels and to allow side effects to be detected before travel so that possible alternatives can be considered.”8
Centers for Disease Control and Prevention recommendations integrate recommendations from WHO and Cochrane.
Acknowledgments
The opinions and assertions contained herein are the private views of the authors and not to be construed as official, or as reflecting the views of the US Air Force Medical Service or the US Air Force at large.
