Malaria: Chemoprophylaxis

Travellers should be counselled on the importance of completing the full course of treatment, particularly during and after the stay in the endemic region.

The initial trial period before travel is necessary to ensure the antimalarial is tolerated and that adequate blood levels are achieved.

Points to consider when recommending an appropriate regimen:

  • Which countries are being visited?
  • What is the itinerary? Which specific regions are being visited? Is it a rural or urban location?
  • Who is travelling? Ages and medical history.
  • What is the duration of the visit?
  • Has the traveller taken the medicine before safely or have they had an adverse reaction?
  • Is the recommended regimen cautioned or contra-indicated for the traveller?
  • Are there any drug interactions with the traveller’s regular medication?

Use the A-Z of travel destinations to find the destination and determine the recommended regimen.

Each page contains:

  • Level of risk within specific regions.
  • Any specific period of risk.
  • If resistance to chemoprophylaxis is present.

You need to find the specific destinations within a country to provide accurate advice; country maps are available on FitForTravel website via the links on each page.

The explanatory notes providing further clarification of the country-specific data within the chart can be found here:

Key to Malaria Chart

Once the preferred regimen is identified you should use the chemoprophylaxis chart below to check its suitability for each traveller. Be aware that individual travellers within the same party may require different chemoprophylaxis due to their age or the presence of contra-indications or interactions.

This chart also gives you information on the dosage schedule as well as dose adjustments for children. Refer to the BNF where necessary for full details of each prophylaxis regimen.

Chemoprophylaxis regimens

REGIMEN Atovaquone/ Proguanil (Malarone) Chloroquine Doxycycline Mefloquine Proguanil ***
SCHEDULE 1-2 days before and 7 days after 1 week before and 4 weeks after 1-2 days before and 4 weeks after 2-3 weeks before and 4 weeks after ** 1 week before and 4 weeks after
FREQUENCY ONCE DAILY ONCE WEEKLY ONCE DAILY ONCE WEEKLY ONCE DAILY
ADULTS 1 x 350mg tablet 2 x 250mg tablets 1 x 100mg capsule 1 x 250mg tablet 2 X 100mg tablet
INFANT (up to 12 wks or under 6kg) 5-8kg = ½ x 87.5mg tablet (unlicensed) 37.5mg base = ¼ tablet or 3.75ml syrup CONTRA-INDICATED CONTRA-INDICATED 25mg = ¼ tablet
INFANT (12wks -1yr or 6-10kg) >8-10kg = ¾ x 87.5mg tablet (unlicensed) 75mg base = ½ tablet or 7.5ml syrup CONTRA-INDICATED 62.5mg = ¼ tablet 50mg = ½ tablet
CHILD (1-4yrs or 10-16kg) 11-21kg = 1 x 87.5mg tablet 112.5mg base = ¾ tablet or 11.25ml syrup CONTRA-INDICATED 62.5mg = ¼ tablet 75mg = ¾ tablet
CHILD (4-8yrs or 16-25kg) 21-31kg = 2 x 87.5mg tablet 150mg base = 1 tablet or 15ml syrup CONTRA-INDICATED 125mg = ½ tablet 100mg = 1 tablet
CHILD (8-13yrs or 25-45kg) 31-40kg = 3 x 87.5mg tablet 225mg base = 1½ tablets or 22.5ml syrup CHILD OVER 12 YEARS = ADULT DOSE 187.5mg = ¾ tablet 150mg = 1½ tablets
CAUTIONS AND PRECAUTIONS Avoid in pregnancy and breast-feeding unless no alternative May exacerbate psoriasis, avoid in epilepsy Absorption decreased by antacids, avoid in pregnancy, may cause photosensitivity, n,v,d Avoid in epilepsy, avoid in pregnancy unless no alternative May be used in pregnancy (folic acid 5mg required)
LICENSED DURATION 28 days but safety shown up to one year May be taken for periods exceeding 5 years Up to 2 years Licensed up to 12 months but safety shown up to 3 years May be taken for periods exceeding 5 years

** ACMP advises taking mefloquine 2-3 weeks before travel to ensure tolerability. Note that the SPC of Lariam now recommends starting 10 days before travel.
*** Note that the dosages of proguanil are taken from the BNFC and may differ to those in product literature.

Cautions and contra-indications

  REGIMEN
CONDITION Atovaquone/ Proguanil Chloroquine Doxycycline Mefloquine Proguanil
Hepatic impairment Only use if no alternative Do not use Do not use Only use if no alternative Only use if no alternative
Renal impairment Do not use Reduce dose Ok to use Ok to use Reduce dose
Pregnancy Only use if no alternative Ok to use Only use if no alternative Only use if no alternative Give folate
Breast-feeding Only use if no alternative Ok to use Do not use Only use if no alternative Ok to use
Epilepsy Ok to use Do not use Ok to use Do not use Ok to use
Psoriasis Ok to use Do not use Ok to use Ok to use Ok to use
SIDE EFFECTS          
Nausea, vomiting or diarrhoea Yes Yes Yes Yes Yes - mild
Photosensitivity reactions No No Yes No No
Sleep disturbances Yes No No Yes No