Choosing a Drug to Prevent Malaria (2024)

Drug/Dosage

Reasons that might make you consider using this drug

Reasons that might make you avoid using this drug

Atovaquone/Proguanil (Malarone)

Begin 1 – 2 days before travel, daily during travel, and for 7 days after leaving.

Adults: 1 adult tablet daily.

Children: 5-8 kg: ½ pediatric tablet daily.
>8-10 kg: ¾ 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 and over: 1 adult tablet daily.

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

See Also

Travelling to India

Adults: 100 mg daily.

Children: ≥8 years old: 2.2 mg/kg (maximum is adult dose) daily.

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 vagin*l 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

Begin 1 – 2 weeks before travel, weekly during travel, and for 4 weeks after leaving.

Adults: 228 mg base (250 mg salt), weekly.

Children: ≤9 kg: 4.6 mg/kg base (5 mg/kg salt), weekly.
>9-19 kg: ¼ tablet weekly. >19-30 kg: ½ tablet weekly.
>30-45 kg: ¾ tablet weekly.
>45 kg: 1 tablet weekly.

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 tobe 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

Begin 1 – 2 days prior to travel, daily during travel, and for 7 days after leaving

Adults: 30 mg base (52.6 mg salt), daily

Children: 0.5 mg/kg base (0.8 mg/kg salt) up to adult dose daily

It is one of the most effective medicines 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

Tafenoquine (Arakoda^TM)

Begin daily for 3 days prior to travel, weekly during travel, and for 1 week after leaving.

Adults only: 200 mg per dose.

One of the most effective drugs for prevention of P. vivax malaria, but also prevents P. falciparum
Good choice for shorter trips because you only have to take the medicine once, 1 week after traveling rather than 4 weeks
Good for last-minute travelers because the drug is started 3 days before traveling to an area where malaria transmission occurs

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 tafenoquine is considered
Cannot be used by children
Cannot be used by pregnant women
Cannot be used by women who are breastfeeding unless the infant has also been tested for G6PD deficiency
Not recommended in those with psychotic disorders